Anemia Part 2 Flashcards by Makenzie Cook

Cause of aplastic anemia

Failure of hematopoietic bone marrow due to suppression of or injury to stem cells

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What can cause injury or suppression to the stem cells?

Radiation
Pregnancy
Toxins
Chemotherapy

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Pathology of aplastic anemia

Hypoplasia of hematopoietic bone marrow leads to decrease in all types of blood cells

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Presentation of aplastic anemia

Pallor
Purpura
Petechiae

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Treatment of aplastic anemia

Red cell transfusions
Platelet transfusions
Bone marrow growth factors
Bone marrow transplant

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MOA of epogen

EPO made via recombinant DNA technology which stimulates division and differentiation of erythroid precursors

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Erythroid precursors

Reticulocytes and RBC

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Indications for epogen

Anemia due to CKD and chemo

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Contraindications for epogen

Uncontrolled HTN

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Monitoring for epogen

Iron status (making new RBC so we are using up all our iron)

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Darbepoetin MOA

EPO recombinant that stimulated division and differentiation of erythroid precursors

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Indications for darbepoetin

Anemia due to CKD and chemo

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Contraindications for darbepoetin

Uncontrolled HTN

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Monitoring for darbepoetin

Iron levels

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Sideroblastic anemia

Anemia caused by inability to use available iron to manufacture hemoglobin

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Cause of sideroblastic anemia

Congenital (X-linked)
Acquired (alcoholism MC)

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Etiology of sideroblastic anemia

Decreased Hbg synthesis due to inability to make protoporphyrin which is a precursor to heme

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Presentation of sideroblastic anemia

Pallor of conjunctiva
Palmar creases

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What must you perform to make a sideroblastic anemia diagnosis?

Bone marrow aspirate

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Erythroid hyperplasia indicates ___

Ineffective erythropoiesis

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Prussian blue stain

Shows ringed sideroblasts (erythrocytes with iron deposits in mitochondria encircling the nucleus)

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Treatment of sideroblastic anemia

Correction of underlying cause
Transfusions
Stop medication if it is drug induced

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Most common anemia worldwide

Iron deficiency anemia

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Ferroportin

Major iron transporter

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Hepcidin

Promotes ferroportin breakdown and iron release

Causes of iron deficiency anemia

Deficient diet Chronic blood loss Malabsorption disorder Increased requirements

Presentation of iron deficiency anemia

Pallor of conjunctiva Fatigue Cheilosis Smooth tongue Pica

Treatment of iron deficiency anemia

Transfusions Iron replacement

Iron dextran

Older form of parenteral iron that was infused slowly and caused iron staining

Newer forms of parenteral iron

Don't have as severe of side effects and are infused over minutes

MOA of ferrous sulfate

Replaces iron found naturally in the body

Indications for ferrous sulfate

Iron deficiency anemia

Side effects of ferrous sulfate

N/V Constipation Stool color changes

Dosing considerations for ferrous sulfate

Best absorbed on an empty stomach

Cause of anemia of inflammation

Proinflammatory cytokines increases hepcidin which decreases iron absorption and availability

Presentation of anemia of inflammation

Mimics iron deficiency anemia

How to differentiate between iron deficiency anemia and anemia of inflammation?

Ferritin is increased in anemia of inflammation, where it is decreased in iron deficiency anemia

Cause of anemia of chronic kidney disease

Failure to secrete adequate EPO by kidneys

Presentation of anemia of chronic kidney disease

Known history of CKD Anemic symptoms

What type of anemia is related to decreased protein intake?

Anemia of starvation

What type of anemia is related to cholesterol deposits in RBC membrane?

Anemia of chronic liver disease

Cause of anemia in the elderly

Resistance to EPO, decreased EPO secretion, and chronic low-level inflammation

Treatment of anemia of chronic disease

Correction or management of underlying disease Transfusions EPO

Role of vitamin B12

Involved in DNA synthesis and erythroid precursor production

Source of vitamin B12

Animal foods and fortified foods

What is needed to absorb B12?

Intrinsic factor

T/F - a plant based diet can lead to B12 deficiency

True

Causes of B12 deficiency

Dietary deficiency Decreased intrinsic factor Malabsorption issues

What are possible reasons for decreased intrinsic factor?

Pernicious anemia Gastric bypass surgery

Pernicious anemia

Autoimmune Ig to gastric parietal cells, intrinsic factor, or both

Presentation of B12 deficiency

Anemia Glossitis Cheilosis Fatigue Neuropathy

Schilling test

A diagnostic analysis for pernicious anemia

Tests for pernicious anemia

Gastrin levels Anti-intrinsic factor antibodies Gastric biopsy Anti-parietal cell antibodies

Treatment of B12 deficiency

B12 injections Oral B12 Folic acid Transfusions

How long do we continue B12 therapy?

If the patient is diet deficient, they would only need to be on it until their diet is controlled Most patients are on it indefinitely since there's no harm

MOA of cyanocobalamin

Replaces cobalamin found in the human body

Indications of cyanocobalamin

Management of B12 deficiency

Monitoring of cyanocobalamin

CBC and B12 level every 3-6 months

Role of folic acid

Conversion of homocysteine to methionine and involved in DNA synthesis in erythroid precursors

Source of folic acid

Fruits and vegetables

Absorption of folic acid

Upper small intestine

Causes of folic acid deficiency

Diet Increased requirement Malabsorption

mnemonic for metabolite absorption sites

Dude Is Just Feeling Ill Bro Duodenum - iron Jejunum - folate Ileum - B12

Presentation of folic acid deficiency

Anemia Glossitis Cheilosis Fatigue NO neuropathy

Treatment for folic acid deficiency

Replacement Preventative supplementation

What do you need to monitor while your patient is taking folic acid?

Hgb

Myeloproliferative disorders

Diverse group of disorders categorized by excessive growth of one or more hematopoietic stem cell lines

Polycythemia vera

Excessive production of all blood cells

Myelofibrosis

Excessive production of collagen or fibrous tissue in the marrow

Chronic myelogenous leukemia

Excessive production of granulocytes

Presentation of myeloproliferative disorders

Splenomegaly Hepatomegaly Easy bruising Petechiae

How do myeloproliferative disorders affect anemia?

They can suppress the erythroid precursors

Treatment of myeloproliferative disorders

Myelosuppression