Anemia of Chronic Dz

Question 1

Pathophysiology of Anemia of Chronic Dz

Answer 1

• infectious, inflammatory or neoplastic dzs lasting more than 1-2 months
• shortened RBC life span
• bone marrow response to EPO is decreased
• cause is uncertain

Question 2

Lab Findings in Anemia of Chronic Dz

Answer 2

• decreased serum iron
• normal or increased serum ferritin
• normal or decreased TIBC

Question 3

Tx of Anemia of Chronic Dz

Answer 3

• treat underlying disorder
• correct reversible causes of anemia
• RBC transfusions
• EPO stimulzating agents

Question 4

How are EPO stimulating agents used in chemotherapy induced anemia?

Answer 4

-restricted to anemia without a curative intent due to increased mortality

Question 5

Pathophysiology of Chronic Renal Failure

Answer 5

• decreased EPO production by the kidneys
• uremic environment shortens RBC life span
• increased demand for folic acid and RBC production can cause folic acid deficiency
• blood and iron loss from hemodialysis can cause IDA

Question 6

What is used to treat anemia of chronic renal failure?

Answer 6

• epoetin alpha (Epogen)

- darbepoetin alpha (Aranesp)

Question 7

What is the Hgb goal with epoetin alpha and darbepoetin alpha?

Answer 7

-hgb 11-12 gm/dL

Question 8

AEs of Recombinant EPO Meds

Answer 8

• DBP elevation (30-47%)
• fatigue, HA, fever
• edema, chest pain
• N/V/D
• arthralgias
• iron deficiency

Question 9

What are the current recommendations for recombinant EPO med usage in pts with chronic kidney dz?

Answer 9

• targeted hgb no longer recommended for CKD pts
• hgb > 11 has increased risk of MI, stroke, death
• recommend using lowest possible dose that reduces need for blood transfusions (stop if hgb > 10)