Anemia Treatment Flashcards
Anemia definitiin
Decrease in the number, size, or Hgb content of erythrocyte/RBC
Common vitamins that lead to anemia
1) iron - necessary for DNA synthesis
2) Vitamin b12 (cyanocobalamin)
3) Folic acid- supports DNA synthesis
Cause of anemia
1) blood loss
2) hemolysis
3) bone marrow dysfunction
4) vitamin/mineral deficiency
5) malnutrition
6) impaired renal function
vitamin b12 compounds
a group of compounds with similar structure all containing an atom of colbalt- cyanocobalamin
Reversal of anemia length of time
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
Vitamin b12 action
helps catalyze the conversion of folic acid to its active form
Vitamin b12 absorption
Requires intrinsic factor- a complex formed between the two to promote absorption
Deficiency of vitamin b12 caused by what 3 things?
1) regional enteritis
2) celiac disease
3) antibodies against b12- IF complexes OR a deficiency of IF called pernicious anemia
Megaloblastic anemia/ macrocytic anemia treatment
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
Megaloblastic/macrocytic anemia if left untreated
Severe anemia can precipitate leading to peripheral and cerebral hypoxia, heart failure, dysrhythmias, and death
Megaloblastic/macrocytic anemia leads to…?
lacking sufficient DNA, growing cells are unable to divide- thus producing oversized cells
Megaloblastic/macrocytic anemia is?
most common consequence of vitamin b12 deficiency- an anemia resulting in large numbers of megaloblasts in the bm and MACROCYTES
Cyanocobalamin (vitamin b 12) indications
treatment and prevention
- doses varies depending on degree of deficiency/ anemia - 1000 mcg x 1 week then weekly then monthly
Cyanocobalamin (vitamin b 12) MOA
1) catalyzes the conversion of folic acid to its active form
2) influences cell growth and division of DNA synthesis
Routes of Cyanocobalamin (vitamin b 12)
1) oral tab
2) IM
3) nasal spray (expensive)
Folic acid deficiency presentation
similar to vitamin b12 deficiency with megaloblastic anemia
folic acid use
it is essential to determine whether the deficiency of vitamin b12, folic acid, or both
how is folic acid conversion
converted to b12 however, alternate pathways do exist- it can be sufficient to treat anemia if large amounts of folic acid are consume
how does folic acid deficiency occur
most often caused by excessive alcohol consumption and alcohol-induced injury to the liver
OR
insufficient folic acid in the diet
Potential hazard of folic acid
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
Potential Hazard of folic acid
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
Potential Hazard of folic acid
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
Folic acid indications
megaloblastic and macrocytic anemia d/t folate deficiency
MOA folic acid
influences cell growth and division via DNA synthesis - catalyzed many other metabolic processes
Treating Folic Acid Deficiency
- 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
