Anemia Therapeutics Flashcards
What is anemia?
Low RBC or hemoglobin
How to diagnose anemia
Look at lab values and signs and symptoms
What are the signs and symptoms of anemia
Exertional dyspnea
Angina
Tachycardia
Fatigue
Pallor
could be asymptomatic
what is Hgb for men
13.5-18
what is Hgb for women
12-16
what is MCV normal
80-100
what is RDW
variation is size of RBCs
What are the 3 main causes of anemia
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)
What is microcytic anemia
MCV < 80
iron deficiency, sickle cell
what is normocytic
MCV 80-100
chronic disease, blood loss, hemolysis
what is macrocytic
MCV > 100
folic acid and or b12 deficiency
What are the goals of therapy for anemia
Increase Hgb
Relieve symptoms
Reduce morbidity
Improve QOL
Reduce mortality
not just normalize the labs!
Labs for iron deficiency anemia
dec Hgb
dec MCV
dec ferritin
dec serum iron
dec TSAT
what is the goal ferritin
15-200
what is the goal TSAT
20-50%
what are causes of iron deficiency
-blood loss
-decreased absorption (celiacs or bypass)
-vegetarian diet
-pregnancy
what are additional signs of iron deficient anema
spoon shaped nails
inflamed tongue
pica (ice)
how to treat iron deficiency anemia
Oral iron
address underlying cause
when is oral iron not preferred
cannot tolerate SE
cannot absorb
ESRD
HF
How much oral iron for anemia?
65mg elemental iron every day
120-200mg elemental iron bid/tid
why is every other day iron better?
hepcidin levels will rise and then fall by the time next dose is due
how much elemental iron is in 300mg of ferrous fumarate
100mg
how much elemental iron is in 325mg of ferrous sulfate
65mg
how much elemental iron is in 300mg of ferrous gluconate
30mg
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
when to use IV iron
ESRD
HF
Malabsorption
Failed oral iron
side effects of IV iron
hypotension during infusion
skin tattooing
lab values for B12 deficient anemia
dec Hgb
inc MCV
inc RDW
ferritin and TSAT not affected
dec B12
inc methylmalonic acid
what are causes of B12 deficiency
diet (vege or alcoholism)
Lack of intrinsic factor
dec absorption
meds (PPIs, metformin)
How to treat b12 deficient anemia
replace b12
IM or deep SC
oral option
when to not give oral b12
when neuro symptoms are present
b12 dosing
1000-2000 mcg/day
Labs for folic acid iron deficiency
dec Hgb
inc MCV
inc RDW
ferritin/TSAT normal
serum folate < 5
inc homocysteine
what are the causes of folic acid deficiency
malabsorption
malnutrition
alcoholism
medications
what medications cause folic acid deficiency
methotrexate
phenytoin
sulfasalazine
SMZ-TMP
How to treat folic acid deficiency
oral folic acid
1-5mg daily until Hgb normalizes
treat underlying cause
what should always be checked before replacing folic acid?
B12 deficiency
what are the common chronic diseases that lead to anemia
CKD
CHF
cancer
HIV/AIDs
what should be avoided in anemia of CKD
blood transfusions
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
what are ESAs place in therapy for anemia of CKD?
Prevent blood transfusions
Keep Hgb > 10
how to treat anemia in HF
IV iron only in class II or III
how does iv iron help HF patients according to trials
decrease hospitalizations but do not decrease mortality
can you use oral iron in HF
no
what are the types of hemolytic anemia?
Intertied: sickle cel, G6PD deficiency
Acquired: drug induced
what is sickle cell anemia
RBCs are irregular shape
collect in spleen and destroyed faster than they can be produced
How to treat sickle cell
Folic acid
Blood transfusions
Hydroxyurea
Pain control
what should you be cautious of when doing blood transfusions in sickle cell patients
iron overload from frequent transfusions
