ANEMIAS Flashcards
metabolic functions of iron
essential to the function of Hemoglobin, myoglobin (oxygen storing molecule of muscle), and a variety of iron containing enzymes
most (70-80% ) of bodies iron in stored in hemoglobin
how does pregnancy affect iron needs?
iron requirements increase dramatically r/t
1- expansion of maternal blood volume
2) production of RBCs by the fetus
iron supplements typically required as supplemntation
causes of iron deficiency
imbalance between iron uptake and iron demand
increased demand r/t
1) increased blood volume during pregnancy
2) blood volume expansion during infancy and early childhood
3) chronic blood loss (GI bleed or Uterine in nature)
consequences of iron deficiency
iron deficiency anemia
in the absence of iron for hemoglobin production
red blood cells become microcytic (smaller) and hypochromic (less color)
reduced carrying capacity of oxygen
fatigue, listless, tachycardic, pallor, dyspnea, angina
in young children can cause developmental issues
in school age children - cognitive issues
diagnosis of anemia
1) presence of microcytic and hypochromatic rbcs
2) absence of hemosiderin in bone marrow
reduced RBC count
reduced hgb and hct
when iron deficiency anemia is Dx must find underlying cause
Ferrous Sulfate
tx of choice for iron deficiency anemia
also 1st choice for preventing iron deficiency in pregnancy or other times when diet is insufficient
less expensive than ferrous gluconate or ferrous fumarate but equal efficacy
adverse effects of ferrous sulfate?
GI disturbances (nausea, heartburn, diarrhea, bloating, constipation)
typically at worst during initial therapy and less disturbing w/ continued therapy
people w/ Ulcers should not take iron by mouth (can aggravate and make worse)
iron can make stools dark green to cbalck (harmless effect)
pt education with iron
can cause tooth staining, rinse mouth after use, dilute liquid iron with water, admin through a straw or dropper
Iron toxicity
in large amounts iron is toxic
poisoning almost always from accidental or intential OD, not by taking therapuetic dose
death in adults is rare
in children iron containing products are among the LEADING causes of POISONINGS 2-10 g is lethal dose for children
should be stored in child proof container
Drug interactions with iron
antacids REDUCE the absorption of iron
coadministration w/ tetracyclines REDUCES absorption of BOTH drugs
VIT C PROMOTES iron absorption, but also increases its adverse effects
(combining iron w/ Vit C no more benefit than just increasing iron dose)
what is carbonyl iron?
pure elemental iron in the form of microparticles
therapuetic effect similar to ferrous salts
absorbed more slowly so risk for toxicity reduced
much higher dose needed to cause harm
reduced risk to children for accidental OD
assessing pt for iron deficiency treatment
assess cause of iron deficiency
treatment goal to increase production of hemoglobin and erythrocytes
if tx successful
reticulocytes increase in 4-7 days
increase in hgb and hct in 1 week
hgb levels rise at least 2g/dl in 1 month
if responses fail
1) compliance?
2) inflammatory issues?
3) bleeding?
4) malabsorption of oral iron?
duration of therapy for iron
until hgb is normal (usually 1-2 months)
then dietry only, evaluate is supplementation is necessary
vitamin B12 deficiency results in
anemia and injury to the nervous system
could also cause GI disturbances
what is the metabolic function of B12
essential for the synthesis of DNA, required for the growth and division of nearly all cells
activates folic acid to create DNA synthesis
