Anemia

Question 1

What are reticulocytes?

Answer 1

Immature RBCs

Question 2

What is the lifespan of RBCs?

Answer 2

120 days

Question 3

What are the 3 causes of anemia

Answer 3

Impaired RBC production
Increased RBC destruction
Blood loss

Question 4

What are classic symptoms of anemia?

Answer 4

fatigue, weakness, SOB, exercise intolerance, HA, dizziness, pallor

Question 5

What are symptoms of iron deficiency anemia?

Answer 5

Glossitis (inflamed, sore tongue), koilonychias (thin spoon-shaped nails), pica (craving chalk and clay)

Question 6

What are symptoms of B12 deficiency anemia?

Answer 6

Neurologic symptoms including peripheral neuropathies, visual disturbances, and/or psychiatric symptoms

Question 7

What does a low/high MCV indicate?

Answer 7

Low: RBC are small (microcytic)
High: RBC are large (macrocytic)

Question 8

What is normal MCV?

Answer 8

80-100

Question 9

Causes of microcytic, normocytic, and macrocytic anemia?

Answer 9

Micro: iron deficiency
Normo: acute blood loss, malignancy, CKD< bone marrow failure, hemolysis (chronic disease)
Macro: B12 or folate deficiency

Question 10

When are reticulocyte counts high or low?

Answer 10

Low: untreated anemia d/t iron, folate, or B12 deficiency
High: acute blood loss or hemolysis

Question 11

Causes of iron deficiency anemia

Answer 11

Inadequate intake: vegetarian, malnutrition, disease-related
Blood loss: acute or chronic
Decreased absorption: high stomach pH, GI disease
Increased iron requirements: pregnancy, lactation, infants, rapid growth

Question 12

Are the serum iron, ferritin, TSAT and TIBC low or high in iron deficiency anemia?

Answer 12

Serum iron, ferritin, TSAT - low

TIBC - high

Question 13

How much oral iron is recommended each day for iron deficiency anemia?

Answer 13

100-200mg elemental iron

Question 14

How should iron be taken? Which medications should not be taken with iron?

Answer 14

Take on empty stomach

Avoid H2RAs and PPIs; separate from antacids

Question 15

What is the percentage of elemental iron in each iron product:
Ferrous gluconate
Ferrous sulfate
Ferrous sulfate, dried
Ferrous fumarate
Carbonyl iron, polysaccharide iron complex, ferric maltol

Answer 15

Ferrous gluconate - 12%
Ferrous sulfate - 20%
Ferrous sulfate, dried - 30%
Ferrous fumarate - 33%
Carbonyl iron, polysaccharide iron complex, ferric maltol - 100%

Question 16

Dosing for:
Ferrous sulfate
Ferrous sulfate, dried
Ferrous gluconate

Answer 16

Ferrous sulfate 325mg (65mg elemental) TID
Ferrous sulfate dried 160mg (50mg elemental) TID
Ferrous gluconate 324mg (38 elemental) TID

Question 17

Oral iron BBW, CI, SE

Answer 17

BBW: accidental overdose is leading cause of fatal poisoning in children <6
CI: hemochromatosis, hemolytic anemia, hemosiderosis
SE: constipation, dark and tarry stools, nausea, stomach upset

Question 18

Antidote for iron overdose

Answer 18

deferoxamine (Desferal)

Question 19

What medications need to be separated from iron?

Answer 19

Antacist, H2RAs, PPIs
Quinolone and tetracycline abx
Bisphosphonates
Cefdinir, dolutegravir, levothyroxine, levodopa, and methyldopa

Question 20

What can be given with iron to increase absorption?

Answer 20

Vitamin C because it is acidic

Question 21

What are IV iron options?

Answer 21

Iron sucrose (venofer)
Ferumoxytol (Feraheme)
Iron dextran (INFeD)
Sodium ferric gluconate (Ferrlecit)
Ferric carboxymaltose (Injectafer)
Ferric derisomaltose (monoferric)
Ferric pyrophosphate citrate (Triferic)

Question 22

Parenteral Iron BBW, SE

Answer 22

BBW: anaphylaxis (iron dextran or ferumoxytol)
SE: Muscle aches, flushing, hypotension, hypertension, tachycardia, chest pain, peripheral edema, hypersensitivity reaction

Question 23

Which parenteral iron medication needs a test dose?

Answer 23

Iron dextran

Question 24

What is pernicious anemia and how is it caused?

Answer 24

Caused by a lack of intrinsic factor, which is required for adequate vitamin B12 absorption
Can NOT treat with oral B12

Question 25

Causes of macrocytic anemia

Answer 25

alcoholism, poor nutrition, gastrointestinal disorder, pregnancy, pernicious anemia

Question 26

What are symptoms of folic acid deficiency anemia

Answer 26

ulcerations of the tongue and oral mucosa, changes to the skin, hair, and fingernail pigmentation

Question 27

Cyanocobalamin CI, warnings, SE

Answer 27

CI: allergy to vitamin B12
Warnings: parenteral products may contain aluminum or benzyl alcohol
SE: pain with injection, rash, polycythemia vera, pulmonary edema (all rare)

Question 28

Folic acid warnings and SE

Answer 28

Warnings: parenteral products may contain aluminum or benzyl alcohol
SE: bronchospasm, flushing, rash, pruritus, malaise (all rare)

Question 29

What medications are ESAs?

Answer 29

Epoetin alfa (Epogen, procrit)
Darbepoetin (Aranesp)

Question 30

ESA BBW, CI, warnings, SE

Answer 30

BBW: increased risk of death, MI, stroke, VTE, thrombosis; use lowes effective dose, do not push Hgb>11
CI: HTN, seizures
SE: arthralgia/bone pain, blood clots, fever, HA, pruritus, N/V, cough

Question 31

Which ESA is given once weekly and which is given 3 times weekly?

Answer 31

Darbapoetin (aranesp) - weekly

Epoetin alfa - 3x weekly

Question 32

What is aplastic anemia?

Answer 32

When the bone marrow fails to make enough RBCs, WBCs, and platelets

Question 33

What medication can be used to treat aplastic anemia

Answer 33

Eltrombopag (Promacta)

Question 34

What does glucose-6-phosphate dehydrogenase (G6PD) deficiency cause and who is it most common in?

Answer 34

Most common in: african, asian, mediterranean, or middle eastern descent
G6PD enzyme protects RBCs from harmful substances

Question 35

Medications that can cause hemolytic anemia (especially in patients with G6PD deficiency)

Answer 35

Cephalosporins
Dapsone
Isoniazid
Levodopa
Methyldopa
Methylene blu
Nitrofurantoin
Pegloticase
PCN
Primaquine
Quinidine
Quinine
Rasburicase
Rifampin
Sulfonamides