Anemia Flashcards
What are reticulocytes?
Immature RBCs
What is the lifespan of RBCs?
120 days
What are the 3 causes of anemia
Impaired RBC production
Increased RBC destruction
Blood loss
What are classic symptoms of anemia?
fatigue, weakness, SOB, exercise intolerance, HA, dizziness, pallor
What are symptoms of iron deficiency anemia?
Glossitis (inflamed, sore tongue), koilonychias (thin spoon-shaped nails), pica (craving chalk and clay)
What are symptoms of B12 deficiency anemia?
Neurologic symptoms including peripheral neuropathies, visual disturbances, and/or psychiatric symptoms
What does a low/high MCV indicate?
Low: RBC are small (microcytic)
High: RBC are large (macrocytic)
What is normal MCV?
80-100
Causes of microcytic, normocytic, and macrocytic anemia?
Micro: iron deficiency
Normo: acute blood loss, malignancy, CKD< bone marrow failure, hemolysis (chronic disease)
Macro: B12 or folate deficiency
When are reticulocyte counts high or low?
Low: untreated anemia d/t iron, folate, or B12 deficiency
High: acute blood loss or hemolysis
Causes of iron deficiency anemia
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
Are the serum iron, ferritin, TSAT and TIBC low or high in iron deficiency anemia?
Serum iron, ferritin, TSAT - low
TIBC - high
How much oral iron is recommended each day for iron deficiency anemia?
100-200mg elemental iron
How should iron be taken? Which medications should not be taken with iron?
Take on empty stomach
Avoid H2RAs and PPIs; separate from antacids
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
Ferrous gluconate - 12% Ferrous sulfate - 20% Ferrous sulfate, dried - 30% Ferrous fumarate - 33% Carbonyl iron, polysaccharide iron complex, ferric maltol - 100%
Dosing for:
Ferrous sulfate
Ferrous sulfate, dried
Ferrous gluconate
Ferrous sulfate 325mg (65mg elemental) TID
Ferrous sulfate dried 160mg (50mg elemental) TID
Ferrous gluconate 324mg (38 elemental) TID
Oral iron BBW, CI, SE
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
Antidote for iron overdose
deferoxamine (Desferal)
What medications need to be separated from iron?
Antacist, H2RAs, PPIs
Quinolone and tetracycline abx
Bisphosphonates
Cefdinir, dolutegravir, levothyroxine, levodopa, and methyldopa
What can be given with iron to increase absorption?
Vitamin C because it is acidic
What are IV iron options?
Iron sucrose (venofer) Ferumoxytol (Feraheme) Iron dextran (INFeD) Sodium ferric gluconate (Ferrlecit) Ferric carboxymaltose (Injectafer) Ferric derisomaltose (monoferric) Ferric pyrophosphate citrate (Triferic)
Parenteral Iron BBW, SE
BBW: anaphylaxis (iron dextran or ferumoxytol)
SE: Muscle aches, flushing, hypotension, hypertension, tachycardia, chest pain, peripheral edema, hypersensitivity reaction
Which parenteral iron medication needs a test dose?
Iron dextran
What is pernicious anemia and how is it caused?
Caused by a lack of intrinsic factor, which is required for adequate vitamin B12 absorption
Can NOT treat with oral B12
Causes of macrocytic anemia
alcoholism, poor nutrition, gastrointestinal disorder, pregnancy, pernicious anemia
What are symptoms of folic acid deficiency anemia
ulcerations of the tongue and oral mucosa, changes to the skin, hair, and fingernail pigmentation
Cyanocobalamin CI, warnings, SE
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)
Folic acid warnings and SE
Warnings: parenteral products may contain aluminum or benzyl alcohol
SE: bronchospasm, flushing, rash, pruritus, malaise (all rare)
What medications are ESAs?
Epoetin alfa (Epogen, procrit) Darbepoetin (Aranesp)
ESA BBW, CI, warnings, SE
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
Which ESA is given once weekly and which is given 3 times weekly?
Darbapoetin (aranesp) - weekly
Epoetin alfa - 3x weekly
What is aplastic anemia?
When the bone marrow fails to make enough RBCs, WBCs, and platelets
What medication can be used to treat aplastic anemia
Eltrombopag (Promacta)
What does glucose-6-phosphate dehydrogenase (G6PD) deficiency cause and who is it most common in?
Most common in: african, asian, mediterranean, or middle eastern descent
G6PD enzyme protects RBCs from harmful substances
Medications that can cause hemolytic anemia (especially in patients with G6PD deficiency)
Cephalosporins Dapsone Isoniazid Levodopa Methyldopa Methylene blu Nitrofurantoin Pegloticase PCN Primaquine Quinidine Quinine Rasburicase Rifampin Sulfonamides
