Anemia and Drug-Induced Hemolysis Flashcards
Outline the cycle of production of RBCs, starting with a stimulus for increased production.
(1) Kidneys release erythropoietin.
(2) Erythropoietin stimulates RBC production in red bone marrow.
(3) Increased RBCs means increased O2 carrying capacity.
These RBCs will remain in circulation for about 120 days.
Define anemia.
a functional inability of blood to properly deliver oxygen to organs to meet metabolic needs
True or False: Anemia is an expression of an underlying disease, not a disease itself.
True
For this reason, treatment of anemia involves acute symptom suppression while searching for the underlying cause to treat.
What are examples of acute anemia symptoms that must be treated immediately?
tachycardia
tachypnea
angina (acute chest syndrome)
Describe the etiology of anemia (3 main sets of causes).
(1) RBC loss (bleeding)
(2) decreased RBC production (kidney dx, iron/b12/folic acid deficiencies)
(3) increased RBC destruction (hemolysis: can be genetic or acquired)
Which demographics are at the highest risk for anemia?
elderly, teenager, female, alcohol abusers, those in poverty, those with poor dentition/GI disease
normal male and female hemoglobin values
male: 13.5-17.5 g/dL
female: 12-16 g/dL
normal hematocrit for males and females
male: 41-53%
female: 36-46%
normal RBC count for males and females
male: 5.2 +/- 0.7 million/mcL
female: 4.6 +/- 0.5 million/mcL
Knowing normal anemia-related values is important, but what must also be considered when a patient’s bloodwork suggests anemia?
their baseline values
Some patients are generally lower in some areas, but may not necessarily be anemic.
normal MCV and RDW values
MCV: 80-100
RDW: 11-15%
Recall and explain 3 special considerations in a patients anemia workup.
(1) acute blood loss: patient’s Hgb or Hct may not drop until 36-48 hours after acute bleed
(2) pregnancy: RBC production increases by 25%, but volume is expanded by 50%, creating a false diluting effect
(3) severe volume depletion: may mask anemia before rehydration
How does smoking affect Hct, and therefore an anemia workup?
Smoking can increase Hct, masking an underlying anemia.
What 3 conditions would likely cause a normocytic anemia?
(1) mixed anemia due to multiple nutrient deficiency
(2) acute bleed
(3) erythropoietin deficiency
Iron deficiency is the most common cause of what kind of anemia?
microcytic (MCV < 80 fL)
clinical manifestations of iron deficiency anemia
(1) pica
(2) angular stomatitis
(3) glossitis
(4) koilonychia
If iron levels are low, TIBC will be ______, and if iron levels are high, TIBC will be _____.
high, low
TIBC is indicative of how much iron your body “wants”. That is why it is high when iron levels are low, and vice versa.
goal for elemental iron daily consumption in IDA
200 mg elemental iron/day
amount of elemental iron in: ferrous sulfate, polysaccharide iron complex, ferrous fumarate, carbonyl iron, ferrous gluconate
ferrous sulfate: 65 mg polysaccharide: 150 mg ferrous fumarate: 99 mg carbonyl iron: 50 mg ferrous gluconate: 35 mg
common SE of PO iron therapy
GI discomfort N/V dark, discolored feces abd cramping constipation (sometimes diarrhea)
What kinds of drugs will interact with PO iron and decrease efficacy? In contrast, what things will increase iron absorption?
(1) anything that affects acid status (PPIs, H2 receptor antagonists), tea, wine, coffee
Vitamin C will increase absorption.
PO Iron patient education
(1) best absorbed on an empty stomach (can eat something small if GI upset, such as a few crackers)
(2) take with glass of OJ to keep environment acidic
(3) add stool softener if constipation becomes a problem
(4) separate from antacids by 2 hours before or 4 hours after
Though oral iron is first-line therapy when possible, what conditions warrant use of IV iron?
(1) severe malabsorption
(2) severe intolerance with oral
(3) dialysis patients (erythropoietin deficiency)
(4) noncompliance with oral therapy
(5) chronic uncorrectable bleeding
True or False: Oral iron resolves anemia slower than IV iron.
false
