Anemia Therapeutics Flashcards

1
Q

What is anemia?

A

Low RBC or hemoglobin

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2
Q

How to diagnose anemia

A

Look at lab values and signs and symptoms

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3
Q

What are the signs and symptoms of anemia

A

Exertional dyspnea
Angina
Tachycardia
Fatigue
Pallor
could be asymptomatic

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4
Q

what is Hgb for men

A

13.5-18

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5
Q

what is Hgb for women

A

12-16

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6
Q

what is MCV normal

A

80-100

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7
Q

what is RDW

A

variation is size of RBCs

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8
Q

What are the 3 main causes of anemia

A

Decreased RBC production (chronic disease or nutritional deficiencies)
Increased RBC destruction (drugs or sickle cell)
Increased RBC loss (acute blood loss or chronic NSAID/ASA use)

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9
Q

What is microcytic anemia

A

MCV < 80
iron deficiency, sickle cell

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10
Q

what is normocytic

A

MCV 80-100
chronic disease, blood loss, hemolysis

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11
Q

what is macrocytic

A

MCV > 100
folic acid and or b12 deficiency

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12
Q

What are the goals of therapy for anemia

A

Increase Hgb
Relieve symptoms
Reduce morbidity
Improve QOL
Reduce mortality
not just normalize the labs!

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13
Q

Labs for iron deficiency anemia

A

dec Hgb
dec MCV
dec ferritin
dec serum iron
dec TSAT

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14
Q

what is the goal ferritin

A

15-200

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15
Q

what is the goal TSAT

A

20-50%

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16
Q

what are causes of iron deficiency

A

-blood loss
-decreased absorption (celiacs or bypass)
-vegetarian diet
-pregnancy

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17
Q

what are additional signs of iron deficient anema

A

spoon shaped nails
inflamed tongue
pica (ice)

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18
Q

how to treat iron deficiency anemia

A

Oral iron
address underlying cause

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19
Q

when is oral iron not preferred

A

cannot tolerate SE
cannot absorb
ESRD
HF

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20
Q

How much oral iron for anemia?

A

65mg elemental iron every day
120-200mg elemental iron bid/tid

21
Q

why is every other day iron better?

A

hepcidin levels will rise and then fall by the time next dose is due

22
Q

how much elemental iron is in 300mg of ferrous fumarate

23
Q

how much elemental iron is in 325mg of ferrous sulfate

24
Q

how much elemental iron is in 300mg of ferrous gluconate

25
what are counseling points for oral iron
inc absorption on empty stomach can cause stomach upset absorption increased with ascorbic acid causes constipation causes dark stools
26
when to use IV iron
ESRD HF Malabsorption Failed oral iron
27
side effects of IV iron
hypotension during infusion skin tattooing
28
lab values for B12 deficient anemia
dec Hgb inc MCV inc RDW ferritin and TSAT not affected dec B12 inc methylmalonic acid
29
what are causes of B12 deficiency
diet (vege or alcoholism) Lack of intrinsic factor dec absorption meds (PPIs, metformin)
30
How to treat b12 deficient anemia
replace b12 IM or deep SC oral option
31
when to not give oral b12
when neuro symptoms are present
32
b12 dosing
1000-2000 mcg/day
33
Labs for folic acid iron deficiency
dec Hgb inc MCV inc RDW ferritin/TSAT normal serum folate < 5 inc homocysteine
34
what are the causes of folic acid deficiency
malabsorption malnutrition alcoholism medications
35
what medications cause folic acid deficiency
methotrexate phenytoin sulfasalazine SMZ-TMP
36
How to treat folic acid deficiency
oral folic acid 1-5mg daily until Hgb normalizes treat underlying cause
37
what should always be checked before replacing folic acid?
B12 deficiency
38
what are the common chronic diseases that lead to anemia
CKD CHF cancer HIV/AIDs
39
what should be avoided in anemia of CKD
blood transfusions
40
what is the treatment for anemia of CKD
correct nutritional deficiencies oral folate/b12 oral iron if not on hemo iv iron if on hemo
41
what are ESAs place in therapy for anemia of CKD?
Prevent blood transfusions Keep Hgb > 10
42
how to treat anemia in HF
IV iron only in class II or III
43
how does iv iron help HF patients according to trials
decrease hospitalizations but do not decrease mortality
44
can you use oral iron in HF
no
45
what are the types of hemolytic anemia?
Intertied: sickle cel, G6PD deficiency Acquired: drug induced
46
what is sickle cell anemia
RBCs are irregular shape collect in spleen and destroyed faster than they can be produced
47
How to treat sickle cell
Folic acid Blood transfusions Hydroxyurea Pain control
48
what should you be cautious of when doing blood transfusions in sickle cell patients
iron overload from frequent transfusions