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Fall Therapeutics > Anemias > Flashcards

Anemias Flashcards

1
Q

Acute Anemia SX

A
  • Palpitations
  • Angina
  • Orthostatic hypotension
  • Shortness of breath

SOAP

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2
Q

Chronic Anemia SX

A
  • Fatigue
  • Dizziness

With exertion/exercise:
* Shortness of breath
* Headache
* Arrhythmias
* Difficulty concentrating
* Pale/cold skin

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2
Q

Objective Signs of Anemia

A
  • Tachycardia, angina pectoris, high output CHF
  • Pale
  • Decrease mental acuity
  • Increase intensity of cardiac valvular murmurs
  • Vit B12 def: diminished vibratory sense or gait due to neurotoxicity
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3
Q

IDA LABS

A
  • ↓ MCV (norm is 82-98), ↓ MCH, ↓ MCHC
  • ↓ Serum iron
  • ↓ Serum ferritin (earliest seen)
  • ↑ TIBC (norm 250-450)**
  • ↓ Transferrin saturation index

everything LOW, except high TIBC

mainly due to blood loss

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4
Q

Unique Effects of IDA

A
  • Glossitis (smooth, waxy tongue)
  • Angular cheilitis (ulcerations on corner of mouth)
  • Koilonychia (spoon shaped nails)
  • Blue sclera
  • Pica

IDA and PG call a KAB

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5
Q

Treatment of IDA

A
  1. Oral iron: tx of choice
  2. IV iron: $$$, becoming more common
  3. Blood transfusions
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6
Q

Oral Iron

A
  • Empty stomach
  • 6 mo (or until Hgb and iron studies are normal)
  • Many drug/food interactions

Most common are ferrous salts, all once daily or every other day
- Sulfate (FerInSol): 325, GOLD standard
- Gluconate (Ferate): 300
- Fumarate (Ferretts): 300

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7
Q

Oral Iron Monitoring (Response, AE, DI)

A
  • Reticulocyte count up by day 14, Hgb up in 3-4 wks
  • Monitor serum ferritin monthly

AE: GI
- constipation, diarrhea, dark stools, epigastric pain, nausea

DI:
- Decrease abs: Tetracycline, cholestyramine, antacids, PPIs/H2RAs
- Increase abs: ascorbic acid

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7
Q

Separate Iron and Levodopa/Methyldopa

A

By >= 2 hrs

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8
Q

Separate Iron and Levothyroxine

A

By >= 4 hrs

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9
Q

Separate Iron and Moxifloxacin

A

Give moxi 4 hr before, 8 hr after

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10
Q

Separate Iron and Ciprofloxacin

A

Give cipro 2 hr before, 6 hr after

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11
Q

Separate Iron and Levofloxacin

A

Give levofloxacin 2 hr before, 2 hr after

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12
Q

Separate Iron and Mycophenolate

A

By >= 4 hrs

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13
Q

Separate Iron and Tetracyclines

A
  • Avoid if possible
  • Give iron 2 hr before, 4 hr after tetra
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14
Q

Separate Iron and Food

A

Give iron 1 hr before or 2 hr after meal

15
Q

Iron and H2RAs/PPIs

A

Monitor for reduced efficacy of iron

16
Q

Separate Iron and Antacids

A

Give iron 2 hours before or 4 hours after antacids

17
Q

Iron and Dietary considerations

A
  • Avoid concurrent tea, coffee
  • Calcium and fiber decrease abs.
  • Iron with meat protein can increase abs.
18
Q

Parenteral Iron Indications

A
  • Inadequate response to oral iron
  • Non-compliance
  • Malabsorption syndromes
  • Continued blood loss
  • Dialysis patients
  • Most products dosed to 1000 mg
19
Q

Parenteral Iron Products and Hypersensitivity

A
  • Ferric Gluconate: 125 mg per session
  • Iron Sucrose: 100 mg per HD, or 200 mg times 5 over 14 days for non-HD
20
Q

Parenteral Iron Products and Anaphylaxis

A
  • Ferumoxytol: 510 mg then another 510 3-8 days later
  • Iron dextran: 100 mg (max)
21
Q

Vitamin B12 Deficiency Anemia

A
  • MCV OVER 100
  • Most common cause is decreased absorption
  • SX: general anemia sx, PLUS neuropsychiatric sx and gastric mucosal atrophy/glossitis
22
Q

Vitamin B12 Deficiency Anemia Labs

A
  • ↓ Serum B12 levels (< 100) (Norm: 211)
  • ↓ Reticulocyte count
  • ↑ MCV (normal is 82-98)
  • ↑ methylmalonic acid (0.4+) & homocysteine levels

homo: norm is <15 so 15+ is high

23
Q

Vitamin B12 TX

A

With SX
- 1000 mcg IM 1-3x week
OR
- 1000 mcg daily for 1 week then weekly for 4 weeks and maintenance of 1000 mcg monthly IM or 1000 mcg PO/SL daily

W/O SX
- 1000 mcg IM weekly for 4 weeks followed by cyanocobalamin monthly
OR
- 1000 or 2000 mcg PO/SL daily

IRR: IM
REV: oral

24
Q

Folic Acid Deficiency Labs

A
  • ↓ Serum folate (< 3.1)
  • ↓ Reticulocyte count
  • ↑ MCV (norm is 82-98)
  • ↑ serum homocysteine levels only (15+)

difference for B12: folate down instead of B12 and ONLY homo up

25
Q

Folic Acid Deficiency SX

A

NO neurological sx, similar to B12/anemia sx

26
Q

Folic Acid Deficiency TX

A

Oral folic acid 1-5 mg daily for >= 4 mo

27
Q

Prophylactic folic acid should be used in

A
  • Pregnant and lactating
  • Patients with ↑ erythropoiesis due to:
  • Chronic hemolysis
  • Myeloproliferative syndromes
28
Q

Anemia of Chronic Disease (ACD) Labs

A
  • ↓ Hgb < 10
  • ↓ Serum iron (hypoferremia)
  • Normal or ↑ serum ferritin
  • ↓ TIBC (difference) < 250
  • Normal iron stores, defect is release
29
Q

ACD Signs/SX

A
  • Fatigue, SOB, edema, mental
  • Generally ELDERLY with many medical problems
  • Cardiac pts can tip over due to increased cardiac demands
30
Q

ACD TX

A
  • TX underlying disease
  • Blood transfusions
  • Erythropoietic agents (not FDA indication)
31
Q

Side effects of erythropoietic agents

A
  • Hypertension
  • Headache, fevers, hypersensitivity
  • ↑ risk of seizure
  • ↑ risk of thromboembolic events
32
Q

ACD Evaluation of Clinical Outcomes

A
  • Maintain Hgb between 10-11
  • Assess QOL
  • Monitor BP
33
Q

Hemolytic Anemias: G6PD Clinical Presentation

A
  • Dark urine (↑ hemoglobinuria)
  • ↓ Hgb
  • ↑ Indirect bilirubin
  • ↑ Reticulocyte count
  • ⊕ Heinz bodies (bite cells)
  • Jaundice, pallor, ↑ RR, splenomegaly
  • Weakness, abd/back pain, fever, chills, tachy
34
Q

Medications/Foods to Avoid with Mod/Sever G6PD Deficiency

A
  • DAPSONE
  • Chlorpropamide
  • Dabrafenib
  • Fava beans, henna, naphthalene, phenyl hydrazine
35
Q

G6PD Treatment

A
  • Avoid or D/C offending drug
  • Transfuse RBCs
  • Hydration and urinary output maintenance

Fall Therapeutics (34 decks)

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