Anemias

Question 1

Anemia consequences

Answer 1

pallor
fatigue
SOB
worsening cardiac disease
cardiac arrest
shock
death

Question 2

Immediate correction –> transfuse

Answer 2

benefit: immediate incr of 1g/dL Hg per unity infused regardless of etiology
Risk: infection, transfusion rxns
process: informed consent, type and cross, premed with APAP and diphenhydramine
infuse 1 unit over 4hr

Question 3

Microcytic

Answer 3

MCV < 80
TIBC > 444: Fe deficiency
250 < TIBC < 444: underlying cause, bone marrow
TIBC < 250: anemia of chronic disease

Question 4

normocytic

Answer 4

MCV 80-100

is bone marrow working? hemolytic anemia or acute blood loss

Question 5

macrocytic

Answer 5

MCV > 100

B12 and/or folate deficiency

Question 6

Iron supplementation

Answer 6

treatment: 300 mg bid-qid
prevention: 300 mg daily
AEs: GI distress, N, constipation
OD can be fatal
intrxns: PPIs, antacids, and H2RA decr abs; vit C enhances abs; coffee, tea, dairy, decr abs
causes dark stools

new RBCs begin to form within 7-10 days
HgB incr 1g/dL per week
requires 3-6mo of therapy

Question 7

IV iron uses

Answer 7

for people who have..
iron malabsoprtion
intolerance
noncompliance
refuse transfusion

Question 8

IV iron dosing

Answer 8

Fe deficiency anemia: Mg iron = Weight x (100 - %Hg) x 0.3
if pt is <30lb, 80%
Blood loss
Mg Iron = blood loss x hematocrit

Question 9

Requirements for dietary intake of B12

Answer 9

acid-pepsin in stomach to liberate b12 from binding to proteins
pancreatic proteases to free B12 from binding to R factors
secretion of intrinsic factor IF by the gastric parietal cells to bind to B12
intact ileum with functional B12-IF receptors

Question 10

Cyanocobalamin

Answer 10

AEs: anxiety, dizziness, worsening of CV disorders

Question 11

folic acid deficiency etiology

Answer 11

poor dietary intake, alcoholism
decreased abs
hyperutilization
inadequate utilization
drugs like MTX or phenytoin