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4 Pharm Self > Anemia (slides only) > Flashcards

Anemia (slides only) Flashcards

1
Q

How many people does iron deficiency anemia effect?

A

1 billion

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2
Q

What hallmark symptoms do we see in severe anemia?

A

fainting, chest pain, angina heart attack

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3
Q

Do we see in or decreased size of spleen in anemia?

A

enlarged

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4
Q

What are the 3 major types of anemia?

A
  1. Dilutional
  2. Decreased RBC production
  3. Increased RBC breakdown
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5
Q

What type of anemia does anemia of prematurity fall under?

A

Dilutional

- reduced EPO, overzealous laboratory testing

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6
Q

How do we get apparent dilution anemia? 3

A
  1. excessive sodium or fluid intake
  2. sodium or water retention, fluid shift intravascular
  3. pregnancy
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7
Q

How many days does it take for erythrocyte development?

A

5.5 days (lasts for 3 months)

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8
Q

How long do reticulocytes stay before becoming erythrocytes?

A

3 days

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9
Q

Pure red blood cell aplasia is also known as what?

A

erythroblastopenia

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10
Q

Review the following things that can cause pure red blood cell aplasia.

A 
autoimmune
thymoma
viral infections (eg HIV, herpes, parvovirus B19)
lymphoproliferative
congenital
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11
Q

What are the 3 main causes of aplastic anemia?

A
  • Fanconi anemia- problem with DNA repair
  • Anemia of Renal failure- insufficient EPO
  • Anemia of endocrine disorders
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12
Q

What cell cyle point is megaloblastic anemia stuck in?

A

G2

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13
Q

what is addisons anemia or biermers anemia?

A

pernicious anemia- intrinsic factor loss

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14
Q

What is the best indicator of iron deficiency anemia?

A

Ferritin

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15
Q

What is iron deficiency anemia almost always due to?

A

insufficient dietary intake of anyone with chronic blood loss (preg women, toddlers, GI bleeds)

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16
Q

What is the most common cause of iron deficiency in the US? in the world?

A

GI bleed

parasitic infection

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17
Q

True or false- the total iron amount in the body is 3.5 grams in it doesn’t take long to deplete stores?

A

False- it is 3.5 g but it takes a while to deplete

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18
Q

If I have ferritin of 20 and normal erythrocytes what might I think? what about ferritin of 10 and normal erythrocytes? what about ferritin <10 and microcytic/hypochromatic erythrocytes?

A
  1. Iron depletion
  2. Iron deficient erythropoiesis
  3. Iron deficiency anemia
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19
Q

Is the oral bioavailability of iron high or low?

A

Very low

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20
Q

What happens to lactate dehydrogenase, haptoglobin, reticulocyte count and bilirubin in hemolytic anemia?

A
  1. increase
  2. decreae
  3. increase
  4. increase
21
Q

Does warm or cold hemolytic anemia occur by IgM?

A

Cold excessive rite permits binding in the cold [think viruses or cancer], Warm is IgG [think autoimmune]

22
Q

If we have anemia with small cells, what should we think about the environment and the genetics?

A

too little iron
too much lead
thalessemias

23
Q

If we have anemia with large cells, what should we think about the environment?

A

too little B12 or B9 or a drug side effect

24
Q

If we have anemia with normal cells but decreased survival, what should we think about the environment and the genetics?

A

acute hemorrhage

sickle cells

25
Q

If we have anemia with normal cells but bad cell development, what should we think about the environment and the genetics?

A

chronic disease or aplastic anemia

G6PD enzyme
cell shape (spherical)
leukemia

26
Q

What helps absorption of oral iron?

A

Vitamin C

27
Q

Are ferrous salts or ferric salts much better?

A

ferrous Fe2+

28
Q

Where is iron absorbed?

A

duodenum and proximal jéjunum

Sustained release pills don’t work well

29
Q

Are oral iron supplement pH dependent?

A

yes! don’t take things that kill the acid

30
Q

Do we dose by salt weight or iron content?

A

salt weight

31
Q

What is the iron RDA does for men and postmenopausal women? pre menopause?

A
  1. 8 mg/d

2. 18 mg/d

32
Q

is heme iron or non-heme iron absorbed better?

A

heme iron from animal source

33
Q

What does fiber, dairy, phosphates and tea do to iron absorption?

A

decreases it

34
Q

When do we use parenteral iron?

A

Speed–deficit would take forever to treat orally

35
Q

What is a big risk to iron injections with erythropoietin?

A

hypersensitivity and anaphylaxis

36
Q

Should patients stay on Iron for a long time?

A

No- chronic iron overload is not good

37
Q

What are the key points to acute iron toxicity?

A
  1. rare except for young children
  2. can be fatal
  3. abdominal pain and blood diarrhea in 30 min
  4. hepatic failure and acidosis, coma,
  5. necrotizing gastorenteritis
38
Q

What are the key points to chronic iron toxicity or hemochromatosis?

A
  1. excess iron is deposited in heart, liver, pancreas–>organ death
  2. can happen to patients with excess ability to absorb or those with parenteral iron on multiple transfusions
  3. do phlebotomy
39
Q

How do we treat iron overdose?

A
  1. gastric aspiration or induced vomiting
  2. Lavage with iron precipitating salts
  3. deferoxamine- iron chelator
40
Q

what is deferoxamine used for?

A

acute iron poisoning or inherited/acquired hemochromatosis

41
Q

rapid IV deferoxamine causes what? long term use?

A

hypotension

neurotoxicity and increased infection

42
Q

What does B12 deficiency cause? B9

A
  1. neurotoxicity and anemia

2. just anemia

43
Q

Can folate compensate for B12?

A

yes for anemia no for neurotoxicity

44
Q

Is blood transfusion recommended for very low Hgb <60 status and no CV instability?

A

No- need to have instability

45
Q

Why don’t we use whole blood transfusion?

A

potassium from lysis is bad

46
Q

Erythropoiesis stim agent ESA should be used in mild and moderate anemia? what about in chronic kidney disease? what does treatment with ESA require?

A
  1. No just to get to lowest acceptable range
  2. No unless extreme anemia of <10g
  3. iron delivery
47
Q

What is used for hemoglobin independent transport to increase oxygen content of plasma?

A

hyperbaric oxygen

48
Q

When do we use the hyperbaric chamber?

A

exceptional blood loss, or when blood transfusions can not be used for various reasons

4 Pharm Self (17 decks)

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