Anemia Treatment

Question 1

Anemia definitiin

Answer 1

Decrease in the number, size, or Hgb content of erythrocyte/RBC

Question 2

Common vitamins that lead to anemia

Answer 2

1) iron - necessary for DNA synthesis
2) Vitamin b12 (cyanocobalamin)
3) Folic acid- supports DNA synthesis

Question 3

Cause of anemia

Answer 3

1) blood loss
2) hemolysis
3) bone marrow dysfunction
4) vitamin/mineral deficiency
5) malnutrition
6) impaired renal function

Question 4

vitamin b12 compounds

Answer 4

a group of compounds with similar structure all containing an atom of colbalt- cyanocobalamin

Question 5

Reversal of anemia length of time

Answer 5

reversal of anemia can happen rapidly, but neurologic damages takes longer to repair and in the event of severe neurologic damage, may never fully resolve

Question 6

Vitamin b12 action

Answer 6

helps catalyze the conversion of folic acid to its active form

Question 7

Vitamin b12 absorption

Answer 7

Requires intrinsic factor- a complex formed between the two to promote absorption

Question 8

Deficiency of vitamin b12 caused by what 3 things?

Answer 8

1) regional enteritis
2) celiac disease
3) antibodies against b12- IF complexes OR a deficiency of IF called pernicious anemia

Question 9

Megaloblastic anemia/ macrocytic anemia treatment

Answer 9

Cyanocobalamin (vitamin b12)

• oral is preferred if absorption is not impaired ( IF deficiency, celiac disease)
• IM/ sub q or nasal spray are used if oral absorption is not adequate

Question 10

Megaloblastic/macrocytic anemia if left untreated

Answer 10

Severe anemia can precipitate leading to peripheral and cerebral hypoxia, heart failure, dysrhythmias, and death

Question 11

Megaloblastic/macrocytic anemia leads to…?

Answer 11

lacking sufficient DNA, growing cells are unable to divide- thus producing oversized cells

Question 12

Megaloblastic/macrocytic anemia is?

Answer 12

most common consequence of vitamin b12 deficiency- an anemia resulting in large numbers of megaloblasts in the bm and MACROCYTES

Question 13

Cyanocobalamin (vitamin b 12) indications

Answer 13

treatment and prevention

- doses varies depending on degree of deficiency/ anemia - 1000 mcg x 1 week then weekly then monthly

Question 14

Cyanocobalamin (vitamin b 12) MOA

Answer 14

1) catalyzes the conversion of folic acid to its active form

2) influences cell growth and division of DNA synthesis

Question 15

Routes of Cyanocobalamin (vitamin b 12)

Answer 15

1) oral tab
2) IM
3) nasal spray (expensive)

Question 16

Folic acid deficiency presentation

Answer 16

similar to vitamin b12 deficiency with megaloblastic anemia

Question 17

folic acid use

Answer 17

it is essential to determine whether the deficiency of vitamin b12, folic acid, or both

Question 18

how is folic acid conversion

Answer 18

converted to b12 however, alternate pathways do exist- it can be sufficient to treat anemia if large amounts of folic acid are consume

Question 19

how does folic acid deficiency occur

Answer 19

most often caused by excessive alcohol consumption and alcohol-induced injury to the liver
OR
insufficient folic acid in the diet

Question 20

Potential hazard of folic acid

Answer 20

1) treatment of anemia with folic acid without correcting vitamin b12 can exacerbate the neurologic consequences of vitamin b12 deficiency
2) folic acid can reverse the hematologic effects but not neurologic effects of b12 deficiency
3) correcting b12 deficiency inadvertently with folic acid can correct the anemia while allowing the neurotoxicity to persist
4) proper precaution and monitoring needs to occur to ensure that b12 levels are corrected and not just anemia corrected if folic acid and cyanocobalamin are used concomitantly

Question 21

Potential Hazard of folic acid

Answer 21

1) treatment of anemia with folic acid without correcting b12 can exacerbate the neurologic consequences of b12 deficiency
2) folic acid can reverse the HEMATOLOGIC effect but not the NEUROLOGIC effects of B12 deficiency
3) correcting b12 def inadvertently with folic acid can correct the anemia while allowing the neurotoxicity to persist
4) proper precuation and monitoring needs to occur to ensure that b12 levels are corrected and not just anemia corrected if folic acid and cyanocobalamin are used concomitantly

Question 22

Potential Hazard of folic acid

Answer 22

1) treatment of anemia with folic acid without correcting b12 can exacerbate the neurologic consequences of b12 deficiency
2) folic acid can reverse the HEMATOLOGIC effect but not the NEUROLOGIC effects of B12 deficiency
3) correcting b12 def inadvertently with folic acid can correct the anemia while allowing the neurotoxicity to persist
4) proper precuation and monitoring needs to occur to ensure that b12 levels are corrected and not just anemia corrected if folic acid and cyanocobalamin are used concomitantly

Question 23

Folic acid indications

Answer 23

megaloblastic and macrocytic anemia d/t folate deficiency

Question 24

MOA folic acid

Answer 24

influences cell growth and division via DNA synthesis - catalyzed many other metabolic processes

Question 25

Treating Folic Acid Deficiency

Answer 25

• oral administration is the preferred route for most patients ( less of an impact of intestinal disease and intrinsic factor does not play a role in absorption)
• avoid general prophylactic us of folic acid for risk of masking b12 deficiency
• in severe megaloblastic anemia deficiency with folic acid deficiency , rapid treatment should be initiated with folic acid AND b12
• effective treatment will resolve megaloblastic presence within 48 hours