Anemia part 1 and 2 Flashcards
anemia
• Decrease in hemoglobin (Hb) level or decreased red blood cells (RBC)
• Hb < 13 mg/dL in men
• Hb < 12 mg/dL in women
May lead to psychomotor and cognitive dysfunction
rbc transport what? from where to where
- RBC transport oxygen from lungs to the rest of the body
* RBCs are formed in bone marrow released into bloodstream and survive ~ 120 days.
Erythropoietin EPO
- Erythropoietin (EPO)- regulatory hormone produced in kidney
- EPO released when tissue oxygen levels decrease
• Classification by size and hemoglobin content of RBC
mean corpuscular volume-
size of the red blood cells
MCV < 80fL = Microcytic
Defects in Hb synthesis
• Iron deficiency
• Thalassemia
• Chronic inflammation
MCV 80 -100 fL= Normocytic
- Acute bleed
- Hemolysis
- Chronic inflammation
- Chronic kidney disease
MCV > 100 fL= Macrocytic
- DNA synthesis defects
- Vitamin B12/folate deficiency
- Drugs
- Alcohol
- Liver/thyroid disease
Pathophysiologic Classifications of
Anemia
• Classifies based on the mechanism of
anemia development like blood loss, Inadequate RBC
production, or excessive rbc desctruction
blood loss
- Acute: trauma
* Chronic: ulcer, vaginal bleeding, aspirin ingestion
Inadequate RBC production
- Nutritional deficiency:
- Bone marrow failure
- Lack of EPO
- Chronic diseases
Excessive RBC destruction
- Intrinsic factors: hereditary (G6PD deficiency)
* Extrinsic factors: autoimmune rxn, drug rxn, infections
• S/sx are unreliable in predicting the degree
of anemia.
gradual onset of anemia
- can tolerate lower Hb
acute onset of anemia
- Tachycardia
- Shortness of breath (SOB)
- Lightheadedness
- Irritability
- Decreased mental acuity
chronic onset of anemia
- Weakness/Fatigue
- Decreased exercise tolerance
- Paleness of the mucous membranes
diagnosis of anemia
CBC with differentials
Mean Corpuscular Hemoglobin (MCH)
Average amount of Hb per RBC
• ↓ MCH: microcytosis and hypochromia (i.e IDA)
• ↑ MCH: macrocytosis (i.e vitamin B12 deficiency)
• Mean Corpuscular Hemoglobin Concentration
MCHC
• Average mount of Hb per unit volume • Concentration of Hb inside a single RBC
Reticulocytes
• Immature RBC
• Indicator of ability of bone marrow to produce
new RBC
• Has lifespan of 1 day before becoming mature
RBCs
positive occult blood
gi bleeding
Transferrin
transport protein that delivers iron to the bone marrow where it’s incorporated into Hb
Ferritin
Stored form of iron
• Reflects total body iron storage
• Low ferritin = iron deficiency anemia (IDA)
- 2 categories of IDA
* Absolute iron deficiency:
lack of total body iron
• Low Tsat and ferritin
• 2 categories of IDA
Functional iron deficiency:
iron availability is not sufficient for intended use
• Low Tsat but normal ferritin
Causes of IDA
• Blood loss
- Acute
* Chronic loss: peptic ulcer disease, hemorrhoids, menstruation
Causes of IDA
• Malabsorption
- Gastric bypass surgery, celiac disease
* Heme iron vs. plant iron
Causes of IDA
• Poor nutrition
• Children/vegan/vegetarian diet
Causes of IDA
• Increased requirement
• Infancy, pregnant/lactating women
signs and symptoms
- smooth tongue
- Brittle or spoon-shaped nails
- Pica- craving for non-food items
- Pagophagia- craving for ice
most sensitive indicator of iron
deficiency?
ferritin levels
< 30 ng/mL indicate IDA
low iron levels results in
high Total Iron-Binding Capacity (TIBC)
Transferrin saturation (Tsat):
Iron immediately available for use bone
marrow for erythropoiesis
• < 20% indicate IDA
severe IDA
Hb, Hct and RBC:
• May remain at normal values until iron levels
significantly fall
Low MCV, low MCHC
• Typically maintain normal values until Hb < 10
g/dL
Low reticulocyte count
iron deficiency anemia
ups and downs
↓ Hgb ↓ Hct ↓ MCHC ↓ Fe ↑ TIBC TSat: < 20%
Which of the following lab values is
NOT specific to PK’s diagnosis?
hemoglobin, because it is low in all types of anemia
Which of the following signs/symptoms
is/are consistent with your diagnosis?
pallor and lack of energy
What is the most likely cause of his
anemia?
GI bleed
PPI could contribute
Ferrous
fumarate
most elemental iron per tablet
• 2 tabs~ 200 mg Fe2+
ferrous sulfate
• 3 tabs~ 200 mg Fe2+
ferrous gluconate
5 tabs~ 200 mg Fe2+
how do you take iron
on empty stomach • Separate from food, especially diary • Separate from antacids Dose: 65-200 mg elemental iron per daily in divided doses start at lower dose and titrate up
iron dextran
• IVP: 100 mg undiluted at ≤ 50 mg/min • IVPB : 500-1000 mg in 250 mL of NS infused over 3-4 hours (for a larger dose) Adverse effects • Anaphylaxis • 25 mg test dose required • Monitor for 1 hour
Sodium ferric
gluconate
• 125 mg IV over 1 hour • Off label: 250 mg but associated with higher incidence of adverse effects Adverse effects • Cramps • Nausea/vomiting • Hypotension
blackbox warning for ferumoxytol (feraheme)
serious hypersensitivity/anaphylaxis reactions
total iron deficit in mg
= [total body weight in kg X (target Hb-actual Hb in g/dL) x 2.4] +500
blood transfusions
Patients with active bleeding
unstable hemodynamics
• Hb < 7 g/dL
temporary solution
