Anemia Part 2 Flashcards
Cause of aplastic anemia
Failure of hematopoietic bone marrow due to suppression of or injury to stem cells
What can cause injury or suppression to the stem cells?
Radiation
Pregnancy
Toxins
Chemotherapy
Pathology of aplastic anemia
Hypoplasia of hematopoietic bone marrow leads to decrease in all types of blood cells
Presentation of aplastic anemia
Pallor
Purpura
Petechiae
Treatment of aplastic anemia
Red cell transfusions
Platelet transfusions
Bone marrow growth factors
Bone marrow transplant
MOA of epogen
EPO made via recombinant DNA technology which stimulates division and differentiation of erythroid precursors
Erythroid precursors
Reticulocytes and RBC
Indications for epogen
Anemia due to CKD and chemo
Contraindications for epogen
Uncontrolled HTN
Monitoring for epogen
Iron status (making new RBC so we are using up all our iron)
Darbepoetin MOA
EPO recombinant that stimulated division and differentiation of erythroid precursors
Indications for darbepoetin
Anemia due to CKD and chemo
Contraindications for darbepoetin
Uncontrolled HTN
Monitoring for darbepoetin
Iron levels
Sideroblastic anemia
Anemia caused by inability to use available iron to manufacture hemoglobin
Cause of sideroblastic anemia
Congenital (X-linked)
Acquired (alcoholism MC)
Etiology of sideroblastic anemia
Decreased Hbg synthesis due to inability to make protoporphyrin which is a precursor to heme
Presentation of sideroblastic anemia
Pallor of conjunctiva
Palmar creases
What must you perform to make a sideroblastic anemia diagnosis?
Bone marrow aspirate
Erythroid hyperplasia indicates ___
Ineffective erythropoiesis
Prussian blue stain
Shows ringed sideroblasts (erythrocytes with iron deposits in mitochondria encircling the nucleus)
Treatment of sideroblastic anemia
Correction of underlying cause
Transfusions
Stop medication if it is drug induced
Most common anemia worldwide
Iron deficiency anemia
Ferroportin
Major iron transporter
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
