Anemia Flashcards
What is haemoglobin?
A protein consisting of four similar polypeptide chains
How does the release of oxygen molecules via haemoglobin occur?
Each polypeptide chain has a binding site for molecular oxygen -> partial pressure of oxygen in blood and tissues -> oxygen molecules released
What is haemoglobin level and give the normal ranges?
Concentration of haemoglobin per unit volume of blood
14g/dL - 17g/dL (men)
12g/dL - 15g/dL (women)
What is haematocrit and give the normal ranges?
% of blood volume composed of erythrocytes
42%-50% (men)
37% - 46% (women)
What is erythropoeitin?
Glycosylated protein
Where is EPO produced in the fetus vs the adult?
Fetus = liver Adult = kidney
Define anemia
Below normal
1) plasma haemaglobin [ ] due to decreased no of circulating RBCs
2) total haemoglobin content per unit of blood volume
<13.5 (men)
<11.5 (women)
Name symptoms of anemia
CNS - fatigue - dizziness - fainting Eyes - yellowing Blood vessels - low BP Heart - palpitations - rapid HR - chest pain - angina - heart attack - arrythmias Respiratory - SOB Muscular - weakness Spleen - enlargement Intestinal - changes in stool colour Skin - pale - cold - yellowing
Name the categories of size variations of RBCs
Normal Microcyte Macrocyte Oval macrocyte Hypochromic macrocyte
Name the categories of haemoglobin distribution in RBCs
Hypochromia 1+, 2+, 3+, 4+
Polychromia
Name the categories of shape variations of RBCs
Target cell Sphreocyte Ovalocyte Stomatocyte Sickle cell Acanthocyte Helmet cell Schistocyte Tear drop Burr cell
Name the categories of inclusions of RBCs
Pappenheimer bodies
Cabot’s ring
Basophilic stippling
Howell-Jolly
Name the categories of red cell distribution of RBCs
Agglutination
Rouleaux
Classify anemia by morphology
- MCV >98
= Macrocytic
- megaloblastic
- non-megaloblastic - Normal MCV
= Normocytic - MCV <78 / MCH <26
= Microcytic
Name the most common causes of blood loss
Menstruation
Drug treatment eg NSAIDs
Pathology eg colon carcinoma
Parasitic infection
Name causes of bone marrow depression
Drug toxicity (anticancer, clozapine) Radiation exposure BM diseases (idiopathic aplastic anemia, leukemia)
Which nutrients are necessary for haemopoeisis?
Iron Folic acid Vitamin B12 Pyridoxine Vitamin C
Name causes of decr production/response to EPO
Chronic renal failure
Rheumatoid arthritis
AIDS
Name causes of microcytic anemia
Iron deficiency
Thalassemia minor
Sideroblastic anemia
Long standing anemia of chronic disease
Name causes of megaloblastic anemia
Vitamin B12 deficiency
Folate deficiency
Name causes of non-megaloblastic anemia
Alcohol Liver cirrhosis Reticulocytosis Hypothyroidism Marrow infiltration Myelodysplastic syndrome Myoproliferative disease
Name causes of vitamin B12 deficiency
Pernicious anemia (lack of IF) Tropical sprue/bacterial overgrowth Ileal disease (Chron's) Fish tapeworm Diet (vegan)
Name causes of folate deficiency
Diet (alcoholics) Malabsorption (Coeliac's) Incr cell turnover - pregnancy - leukemia - chronic haemolysis - chronic inflammation Anti-folate drugs
Name anti-folate drugs
Phenytoin
Methotrexate
Name causes of normocytic aenemia
Bone marrow failure - aplastic anemia - ineffective erythropoesis - infiltration Anemia of chronic disease Haemolytic anemia - intracorpuscular - extracorpuscular
Name causes of aplastic anemia
Drugs (phenytoin, indomethacin, sulfonamides) Radiation SLE Viral hepatitis Pregnancy Fanconi's syndrome
Name causes of ineffective erythropoesis
Myelodysplastic syndrome
Paroxysmal nocturnal hemoglobinuria
Name causes of anemia of chronic disease
Chronic inflammation (abscess, TB, CT disease) Malignancy Endocrine (hypothy, hypopit, Addison's) Liver disease CKD Malnutrition
Name causes of intracorpuscular haemolytic anemia
Hereditary spherocytosis Hereditary elliptocytosis Haemoglobinopathies - thalassemia - PNH - sickle cell disease
Name causes of extracorpuscular haemolytic anemia
Autoimmune Incompatible blood transfusion Hypersplenism Trauma (prosthetic heart valves, marathon runner) Microangiopathys (DIC) Toxic (malaria)
Name causes of bone marrow failure due to infiltration
Leukemia Lymphoma Myeloma Granuloma Myelofibrosis
Name signs of anemia
Pallor Tachycardia Wide pulse pressure Systolic ejection murmurs - rise in CO and HR
How can you treat anemia?
Dependent on the cause
Name the adverse effects of cyanocobalamin
Injection site pain Arthralgia Dizziness Headache Nasopharyngitis Anaphylaxis
Name potential drug interactions with cyanobalamin
PPIs decrease B12 oral absorption
Name the adverse effects of erythropoietin/epoetin alfa
Oedema Pruritis N+V Hyperension CVA Thrombosis
Name potential drug interactions with erythropoietin/epoetin alfa
Darbepoeitin alfa -> incr adverse events
Name the adverse effects of darbepoetin alfa
Oedema Dyspnoea Hypertension CVA Thrombosis
Name potential drug interactions with darbapoetin alfa
Epoetin alfa => adverse events
Name the adverse effects of folic acid
Bad taste in mouth
Nausea
Confusion
Irratibility
Name potential drug interactions with folic acid
Cholestyramine can interfere with its absorption
Name the adverse effects of iron
Pruritis NVD Constipation Headache Anaphylaxis
Name potential drug interactions with iron
Deferoxamine/dimercaprol
Chelate iron
Name treatment options for sickle cell anemia
Hydroxyurea
Pentoxifylline
Name the adverse effects of hydroxyurea
Myelosuppresion
Skin ulcers
Secondary leukemia
Name potential drug interactions with hydroxyurea
HIV medications - decr CD4 count Salicylates - incr bleeding risk Probenecid - incr uric acid
Name the adverse effects of pentoxifylline
NV
Thrombocytopenia
Jaundice
Anaphylaxis
Name potential drug interactions with pentoxifylline
Ketorolac
- incr bleeding risk
Gingko biloba
- incr antiplatelet effect
Name the available iron formulations
Ferrous gluconate Ferric ammonium citrate Ferrous sulfate Anhydrous ferrous sulfate Ferrous fumarate Carbonyl iron Polysaccharide-iron complex
Give the brand name(s) of ferrous gluconate
Fergon
Give the brand name(s) of ferric ammonium citrate
Iron citrate
Give the brand name(s) of ferrous sulfate
Fer-in-sol
Feosol
Give the brand name(s) of ferrous fumarate
Slow-FE
Give the brand name(s) of carbonyl iron
Ferretts
Ferrimin
Hemocyte
Give the brand name(s) of polysaccharide-iron complex
Nu-iron 150
Niferex
Discuss the use of ferrous gluconate
12% elemental iron
Less elemental iron that FS but similar tolerability
Discuss the use of ferric ammonium citrate
18% elemental iron
Less bioavailable than ferrous salts
Intestine needs to reduce it to ferrous form
Discuss the use of ferrous sulfate
20% elemental iron Most common supplement Low cost Good effectiveness Good tolerability
Discuss the use of anhydrous ferrous sulfate
30% elemental iron
Extended release formulation
Higher cost
Discuss the use of ferrous fumarate
33% elemental iron
Similar effectiveness + tolerability to FS
Almost no taste vs other iron salts
Discuss the use of carbonyl iron
100% elemental iron
Microparticles of purified iron
Dissolves in stomach to form HCl salt -> absorbed
Less toxic than iron salts due to slower absorption rate
Discuss the use of polysaccharide-iron complex
100% elemental iron
Tasteless
Odourless
Similar bioavailability to FS
How can you administer erythropoietin?
IV
Subcutaneously
Intraperitoneally
Name adverse effects of EPO
Transient flu-like symptoms
Hypertension
Iron deficiency
Incr blood viscosity
Which drug exacerbates the anemia of AIDS?
Zidovudine
