anemia pt 2 Flashcards
idiopathic autoimmune suppression of ALL hematopoiesis
aplastic anemia
benzene, chemo, hepatitis, radiation exposure, and pregnancy all can cause…
aplastic anemia
pallor, purpura, petechiae can be seen in…
aplastic anemia
hepatomegaly and splenomegaly is typically not seen in aplastic anemia because…
no hemolysis happening
hypocellular aspirate can be seen in
aplastic anemia
eltrombopag (promacta) is tx for…
mild aplastic anemia
boosts RBC AND WBC production
what is the general tx for mild aplastic anemia
- bone marrow growth factors
- multilineage
- erythropoietic
- myeloid
tx for severe aplastic anemia (2)
- bone marrow transplant
- immunosuppression - more ppl that cannot undergo bone marrow transplant
- ATG, cyclosporine
- steroids used with ATG to reduce SE
anemia due to CKD, chemotherapy, myelodysplasia can be given this medication
epoetin/darbepoetin
which has a longer half-life, darbepoetin or epoetin?
darbepoetin
3x of epoetin
contraindication for epoetin/darbepoetin
HTN
BBW: CV stuff, thrombosis stuff, cancer
common SE of epoetin/darbepoetin
HTN, thrombosis
anemia that have abnormalities in heme synthesis and mitochondrial function
sideroblastic anemia
inability to incorporate iron into protoporphyrin IX
sideroblastic anemia
how is sideroblastic anemia inherited/congenital?
X-linked (MC)
autosomal recessive
mitochondrial
cause sideroblastic anemia is more commonly…
acquired
- often part of general myelodysplastic snydrome
- chronic alc
- meds - mostly abx
s/s of anemia, pallor of conjunctiva, palmar creases can be seen in
sideroblastic
what must be ordered to make sideroblastic dx?
bone marrow aspirate
iron deposits in mitochondria encircling the nucleus can be seen in
sideroblastic
ringed sideroblasts
what is the MC cause of anemia worldwide?
iron deficiency
how much iron is overall absorbed?
10% overall normally in acidic environment
name the major iron transporter that releases iron from cells
ferroportin
what promotes ferroportin breakdown and inhibits iron release
hepcidin
what type of med can decrease iron absorption
antiacids
5 causes of iron loss
- diet
- increased requirements - pregnancy, lactation, growth spurt
- chronic blood loss - periods, GI bleeds
- decreased absorption - gastritis, chronic disease
- iron sequestration
chronic intravascular hemolysis/hemoglobinuria - chronic iron loss
heavy periods and GI bleeds (ulcers, IBD, cancer, chronic ASA/NSAID use) can cause what type of anemia
iron deficiency anemia
celiac spue or crohn’s disease can cause what type of anemia
iron deficiency
presentations of:
- smooth tongue, brittle nails, koilonychia, cheilosis
- Pica
- restless leg syndrome
is indicative of…
iron deficiency
plummer-vinson syndrome can be seen in…
iron deficiency
leads to dysphagia
what happens to iron levels during iron deficiency
TIBC - increase
transferrin saturation - decrease
iron - decreased
ferritin - decreased
what is the common iron replacement therapy
ferrous sulfate 325 mg orally 3x daily on empty stomach
what happens to Hct and reticulocytes during iron replacement therapy
Hct - halfway to normal in 3 weeks, baseline in 2 months
reticulocytes - rises in 4-7 days, peak in 1-1.5 weeks
pt that cannot tolerate or absorb iron orally reside to…
parenteral - generally IV infusion
- iron dextran - older form of parenteral iron and has more risk for serious reactions
- newer preparations is more safe and faster
proinflammatory cytokines that decreases iron absorption and availability is caused by…
inflammation/infection anemia
failure to secrete enough EPO is caused by… (disease)
anemia of CKD
EPO secreted by kidneys*
decreased EPO secretion mainly seen in decreased hormone secretion states (thyroid, testosterone cortisol) is caused by…
anemia of endocrine disorders
cholesterol deposits in RBC membrane that shortens RBc survival and inadequate EPO secretion can be seen in…
anemia in chronic liver disease
deposits can increase RBC size (macrocytic)
decreased protein intake that leads to decreased EPO is caused by…
anemia of starvation
3 causes of anemia of the elderly
- resistance to EPO
- decreased EPO secretion
- chronic low-level inflammation
what medication can be given for anemias of chronic disease
EPO
what converts methylmalonyl-CoA to succinyl-CoA and homocysteine to methionine
B12
what helps with absorption of B12
intrinsic factor in stomach
secreted by parietal gastric cells
what is absorbed in the terminal ileum
B12-intrinsic factor
B12 is stored in the…
liver
7 causes of B12 deficiency
- diet - vegan, alc, elderly
- decreased intrinsic factor
- pancreatic insufficiency
- transcobalamin II deficiency
- meds
- competition for B12
- decreased absorption of B12
pernicious anemia and gastric surgery can cause…
B12 deficiency
metformin, proton pump inhibitors, and colchicine can cause…
B12 deficiency
blind loop syndrome can cause…
competition for B12 = B12 deficiency
bacterial overgrowth of small bowel
surgical small bowel resection and Crohn’s disease can cause…
decreased absorption of B12 = B12 deficiency
presentation of B12 deficiency
- anemia
- GI - anorexia, nausea, glossitis, angular cheilitis
- fatigue
- neuro - gradual onset
- initial: peripheral paresthesias
- later: problems with balance and proprioception
- severe: may affect cerebral function
can see non-heme symptoms before anemia mainfests
lab findings of B12 deficiency
MCV - increased (megablasts)
MCH - increased
MCHC - normal
tests for pernicious anemia
- anti-intrinsic factor antibodies
- antiparietal cell antibodies
- gastrin levels - gastric biopsy
- Schilling test
5 tx for B12 deficiency
- B12 injection
- oral B12
- folic acid
- transfusion (rare)
- dietary counseling
what is the response during B12 tx
reticulocytosis in 1 week
CBC normal in 2 months
cyanocoalamin is used for
B12 deficiency
contraindications for ferrous sulfate
- allergy to rx
- hemochromatosis
- hemolytic anemia
contraindication for cyanocobalamin
allergy
maintenance monitoring for cyanocobalamin
CBC and B12 level every 3-6 months
what coenzyme converts homocysteine to methionine
folate
5 causes of folate deficiency
- diet (MC cause)
- increased folate requirement
- pregnancy
- chronic hemolytic anemia
- exfoliative skin disease - inhibition of reduction to active form (methotrexate)
- excess folate loss (hemodialysis)
- decreased absorption of folate
- tropical sprue
- concurrent B12 deficiency
- meds
phenytoin, sulfasalazine, trimethoprim-sulfamethoxazole can cause…
decreased absorption of folate = folate deficiency
what metabolite is absorbed in the duodenum
iron
what metabolite is absorbed in the jejunum
folate
presentation of folate deficiency
similar to B12 but NO NEUROPATHY
response to folate deficiency tx
reticulocytosis in 1 week
CBC normalized in 2 months
SE of folic acid
malise, nausea
allergic rxn - malaise, flushing, erythema, rash, bronchospasms
diverse group of disorders categorized by excessive growth of one or more hematopoitic stem cell lines
myeloproliferative disorders
myeloproliferative disorders can see an increase in: (4)
- polycythemia vera - all hematopoietic cells
- essential thrombocytosis - platelets
- myelofibrosis - collagen, fibrous tissue in marrow
- chronic myelogenous leukemia (CML) - granulocytes
instead of pallor, ruddy facial features (plethora) can be seen in…
myeloproliferative disorder - polycythemia vera
tx for myeloproliferative disorders
usually myelosuppression
