Anemia Exam 4 Flashcards by Briana Echols

What is iron deficiency anemia?

insufficient hemoglobin in RBCs due to lack of iron

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What is Megaloblastic anemia?

Impaired loss of B12 from loss of IF
OR
Deficiency in B12 diet (rare) OR Folate acid (common)

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What are the two forms of Hemolytic anemia?

Acquired and genetic

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What is genetic hemolytic anemia?

deficiency in G6PD

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What is acquired hemolytic anemia?

RBC lysis due to drugs

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What is sickle cell anemia?

seen in sickle cell disease, short life span of RBC

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What are some special conditions caused by abuse in body builders on anabolic steroids?

Anemia caused by kidney failure (Nandrolone)
Anemia caused by insufficient RBC production (Oxymetholone)
Anemia caused by CRF, Zidovudine, Chemo (Erythropoetin and darepoetin)

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What causes Lack of blood?

decrease RBC
- Decrease in production
-RBC loss (bleeding)
-RBC destruction (hemolysis)
decreased hemoglobin

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What decreases RBC production?

low erythropoietin (drug)

- decreased bone marrow response to erythropoietin

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What things can cause Iron deficiency anemia?

Menstruation
GI bleed (PU, L/T NSAIDS)
Inadequate intake
Malabsorption
Pregnancy

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What is the best way to treat iron deficiency anemia?

treat the underlying disease

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What transport iron? What stores iron?

Transferritin

Ferritin

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What percent of iron is absorbed?

10%

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What is ferritin stored?

liver and heart

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What is the most absorbable form of iron?

Ferrous (FE2+) (unbound, soluble)

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What is recommend iron intake?

Oral, elemental Fe2+, FERROUS SULFATE x3-4/d, 100-150mg

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What is the best way to take oral iron? and why?

on a EMPTY stomach, optimal absorptive

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If iron is taken w/ food how much is absorbed?

50%

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How to combat the sde of oral iron?

decreased dose or frequency, rather than change formulation

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What are common sde of oral iron?

n/v, upper abdominal pain, constipation, melena

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What does oral iron have a ddx?

FQ and tetracycline (decreasing them)

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How long does it take for iron to work?

months

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Iron bound to transferrin in circulation is in what form?

Ferric (oxidized) FE3+

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How do you monitor treatment?

check reticulocytes count in 1 wk. Hgb in 1 mo. If Hgb is normal, continue txt for 2-6mo, then stop

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What is a txt if a pt can't take/ respond to oral iron therapy?

IV/IM Iron Dextran

What iron form is iron dextran?

ferric (Fe3+)

Why would iron dextran work better than oral ferrous sulfate?

prevents unbound iron toxicity

What should ALWAYS be done when prescribing iron dextran?

test dose for hypersenstiivity

What symptoms of hypersensitivity is seen in iron dextran?

Fever, hypotension, rash, arthralgia, anaphylaxis | Lymphadenopathy, splenomegaly

What can be done to reduce hypersensitivity of iron dextran?

decrease infusion rate

What are two alternative therapies to iron dextran?

sodium ferric gluconate and iron sucrose

How many grams of iron is need for overdose?

1 to 2 grams

Early changes 1-2 hours of overdose?

vomiting, gastric bleeding

Intermediate changes 8-12 hrs of overdose?

short-lived clinical improvement, followed by shock, CV collapse, pulmonary edema, death (12-24hr)

Late stage (1 month) of overdose?

intestinal scarring, fatty acid degeneration of liver, cirrhosis and death

What is the treatment for iron overdose in the ER?

gastric aspiration and lavage

What is the anti-dote for iron?

Deferoxamine (chelate iron) - oral: for whats unabsorbed - IV/IM: for whats absorbed

What can mess with the gut causing megaloblastic anemia?

- drug induced - ETOH, PPIs, H2 receptor antagonist - Nitrous oxide

What is the role of folic acid?

RBC formation and maturation

Wha form of Folic acid is needed?

"trapped" inactive tetrahydrofolate

A deficiency in B12 causes what sde?

neurological problems

Why you should check and correct B12 first before correcting folate?

because its causes neuro problems and folate just wont work if its a B12 problem

Folate deficiency mostly comes from?

inadequate diet intake

Impaired absorption of B12 resulting from loss of function of ???? that produces ???

gastric parietal cells, intrinsic factor (IF)

What is the role of IF and B12?

binds to B12 protects it form degradation in gut, complex absorbed in ileum

What can cause loss of parietal cells?

- gastric surgery | - autoimmune condition (pernicious anemia)

What is the treatment of B12?

IM- Hydroxy-cobolamin | PO- Cyanocobalamin

Which B12 is usually used in a EMERGENCY?

Hydroxy-cobolamin - IM

T/F a allergy is reported with B12 treatment?

YES- but no like dextran

What common cause of folate anemia?

ETOH, drug induced

What anticonvulsant drugs cause folate deficiency?

3 P's: Phenytoin, Phenobarbital, Primidone

What drugs can are folate antagonists:

``` methotrexate trimethoprim flucytosine pyrimethamine zidovudine ```

What is the treatment for folate deficiency?

oral folate

Before treating folate what must be done?

check B12 first to r/o B12 deficiency

What is a ddx with folate?

phenytoin (decreases)

What is a good thing about G6PD deficiency?

protects against malaria

What is a bad thing about G6PD deficiency

drugs can increase sensitivity to oxidation, causing drug induced hemolysis

What are oxidant drugs?

Sulfonamides, PrimaQUINE, Quinine, dapsone, nitrofurantoin aspirin Raw broad beans (FAVA BEANS)

What causes acquired hemolytic anemia?

Methyldopa, hydralazine, procainamide (SLE)

What is the correlation of acquired/genetic hemolytic anemia drugs?

SHIP drugs

What is used to treat sickle cell pain?

IV opioids (pt controlled), and regular opioids

What is sickle cell?

vessel occlusion with painful crises, due to inherited blood disorder, stretching and distorting Hgb

What is the cell life in sickle cell anemia?

short life span of RBC

What is the treatment for sickle cell anemia?

- daily folic acid (produce RBC) - Hydroxyurea (increase fetal Hgb production) - Stem cell transplantation

What enhances the absorption of iron?

Vitamin C

What reduces absorption of ferrous iron?

antacids