Anemias Flashcards
What Hgb level is considered anemia?
<11
What patients is anemia more common in?
- Women during reproductive year
- Comorbid conditions (cancer, CKD)
What hormone is RBC production stimulated by?
Erythropoietin EPO
Where is erythropoietin produced?
Kidneys
What are the symptoms of anemia?
- fatigue/ lethargy
- shortness of breath
- headache
- edema
- tachycardia
What are the complications of anemia?
- increase in cardiac output due to lack of oxygen
- decreased quality of life
- influences mortality
What are possible causes of decreased RBC production?
- hypoproliferative bone marrow (chancer/chemo)
- decreased production/ response to EPO (CKD/ inflammatory conditions)
- nutritional deficiency (B12, iron)
How does cancer cause anemia?
- hematologic cancer
- bone metastases
- cytokines decrease EPO production
When are RBC transfusions appropriate?
- severe anemia (Hgb <8)
- life-threatening anemia (Hgb <6.6)
- active bleeding
What are the potential complications with RBC transfusions?
- infusion reactions
- infection transmission
- autoantibody development
- hemochromatosis
- brief effects
What agents are erythropoietin stimulating agents and increase the production of RBCs?
- Epoetin alfa (PROCRIT)
- Darbepoetin alfa (ARANESP)
When are erythropoietin stimulating agents commonly used?
treat anemia associated with cancer and chemotherapy
What are adverse effects with erythropoietin stimulating agents?
- venous thromboembolism
- HTN
- Cardiovascular events
- stroke
What outcomes do recent studies of erythropoietin stimulating agents show?
increased mortality
When are erythropoietin stimulating agents NOT recommended?
- patients receiving myelosuppressive chemo with anticipated cure
- treat anemia associated with cancer
- hematologic malignancies
When should erythropoietin stimulating therapy begin and be D/C?
Hgb <10;
Stop when Hgb= 10
The FDA requires that all prescribed erythropoietin stimulating agents be part of a ____________
REMS program
What is the cause of anemia of CKD?
reduced EPO production AND reponse
When should evaluation of anemia if CKD begin?
stage 3 or higher
What is the target Hgb range for those with CKD?
10-12
What agents are used to treat anemia of CKD?
SQ erythropoietin stimulating agents
When are adverse effects of erythropoietin stimulating agents more common is CKD?
target Hgb > 13
How is anemia due to inflammatory conditions treated?
treat underlying condition
What is the most common cause of anemia in children and women of childbearing age?
iron-deficiency
What are the symptoms of iron deficiency anemia?
- hair loss
- pica
- koilonychia (spoon nails)
- angular stomatitis (crusty around the mouth)
Is dietary supplementation of iron adequate to treat anemia?
no
What are the 3 different iron salts available?
sulfate, gluconate, fumarate
How much elemental iron is needed per day for replacement?
200 mg
What can enhance the absorption of iron supplements?
Vitamin C
What can reduce the absorption of iron therapy?
alkaline environment
What are adverse effects of iron replacement?
- constipation
- N/V
- discoloration of feces
- heartburn
When should iron replacement be taken for the best absorption?
1 hour before meals
What drugs can decrease iron absorption?
- Al, Mg, Ca containing products
- tetracyclines
- H2 antagonist
- PPIs
- cholestyramine
- fluoroquinolones
- mycophenolate
- penicillamine
- levodopa
When is parenteral iron used?
- intolerance to oral therapy
- malabsorption
- CKD
- excess continuous blood loss
- chemo/ ESAs
What is the standard dose of parenteral iron?
1000mg
What parenteral iron needs to be tested for hypersensitivity?
- iron dextran
- ferric gluconate
- iron sucrose
What are adverse affects with IV iron?
- anaphylaxis
- infusion-related reactions
- cramps
- diarrhea
- hypotension
What are the causes of B12 deficiency?
- poor intake
- malabsorption
- medications
What are the causes of B12 malabsorption?
- advanced liver disease
- infections (H.pylori, tapeworms, TB)
- GI surgery
What medications can cause B12 deficiency?
- metformin
- phenytoin
- trimethoprim
How is B12 supplemented?
Oral 1000-2000 mcg daily
IM/ IV 1000 mcg monthly
both are equivalent
What are the causes of inadequate intake of folic acid?
- alcoholism
- chronically ill
- demented
- economically challenged
- fad diets
What are the causes of the malabsorption of folic acid?
- alcohol
- drugs
- GI surgery
What are the reasons for increased requirements of folic acid?
- burn patients
- chronic inflammatory conditions
- growth spurts
- malignancy
- pregnancy
What drugs directly inhibit DNA synthesis causing folic acid deficiency?
- Azathioprine
- 5-FU
What drugs act as folate antagonists?
- MTX
- pentamidine
- trimethoprim
- triamterene
What drugs reduce absorption causing folic acid deficiency?
- phenytoin
- phenobarnitol
- primidone
How much folic acid is needed for replacement?
1-5 mg daily
