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Heme/Onc > Anemias > Flashcards

Anemias Flashcards

1
Q

What level of hemoglobin is anemia in men?

A

< 13

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2
Q

What level of hemoglobin is anemia in women?

A

< 12

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3
Q

What do anemias result from?

A

Inadequate RBC production
Increased RBC destruction
Blood loss

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4
Q

What stimulate RBC production?

A

Erythropoietin (EPO)

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5
Q

Where is EPO produced?

A

Kidneys

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6
Q

What is needed for DNA and RNA?

A

Folic acid

Vitamin B12

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7
Q

What is the lifespan of a RBC?

A

120 days

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8
Q

What is transferrin?

A

Transports iron into cell via transferrin receptor

Delivers to bone marrow or storage (liver, spleen)

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9
Q

What element binds O2?

A

Iron

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10
Q

What is TIBC?

A

Blood capacity to bind iron with transferrin

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11
Q

What is ferritin?

A

Storage form of iron

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12
Q

What are the s/sx of chronic development?

A 
Fatigue
HA
Malaise
Exertional dyspnea
Pale
Angina
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13
Q

What are the s/sx of acute development?

A 
Palpitations
Angina
SOB
Lightheaded
Tachycardic
Hypotensive
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14
Q

What are Microcytic anemias?

A

< 80
Iron deficiency anemia (IDA)
Sickle cell
Thalassemias

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15
Q

What are macrocytic anemias?

A 
> 100
B12 deficiency (pernicious anemia)
Folic acid deficiency
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16
Q

What are normocytic anemias?

A 
80-100
Blood loss
Bone marrow failure
Chronic inflammation (malignancy)
Hemolysis (DI)
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17
Q

What are the roles of iron in microcytic anemias?

A

Binds O2

Cell function

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18
Q

What is the recommended intake of iron?

A

8-18 mg

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19
Q

Where does heme iron come from?

A

Beef
Fish
Poultry

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20
Q

Where does non-heme iron come from?

A 
Vegetables
Fruits
Beans
Nuts
Grains
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21
Q

What causes microcytic anemias?

A

Inadequate intake
Inadequate absorption
Increased demands

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22
Q

What causes increased demands for iron?

A

Pregnancy, rapid growth in children
Blood loss
Menstruation, ulcers, trauma, blood donation, arteriovenous malformations

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23
Q

What are the s/sx of IDA?

A

Glossal pain
Pica
Pagophagia
Koilonychias

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24
Q

What extra labs are looked at for IDA?

A

Serum iron (decreased)
TIBC (Increased)
Transferrin (Decreased)
Ferritin (Decreased)

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25
Q

What is the treatment of IDA?

A

Oral supplementation

IV supplementation

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26
Q

What is the dose of oral iron?

A

150-200mg elemental iron in divided doses

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27
Q

How should iron be administered?

A

W/o food

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28
Q

What kind of environment should iron be administered?

A

Acidic

Absorbed in the duodenum

29
Q

What are the AEs of iron?

A

GI

Black stools

30
Q

What drugs decreased iron absorption?

A 
Al
Mg
Ca
Histamine antagonists
PPIs
Tetracyclines
Cholestyramine
31
Q

What drugs are affected by iron?

A 
Levadopa
Methyldopa
Levothyroxine
Penicillins
FQs
Tetracycline, doxycycline
Mycophenolate
32
Q

What is the % iron in the available oral products?

A

Ferrous sulfate 20%
Ferrous gluconate 12%
Ferrous Fumarate 33%
Polysaccharide iron complex 100%

33
Q

When is IV iron supplementation considered?

A

Oral intolerance
Non-adherence
Malabsorption
Refusing transfusions

34
Q

What is IV iron FDA approved for?

A

IDA in CKD

Iron dextran only one approved for non-CKD IDA

35
Q

What is the test dose for iron dextran?

A

25 mg

36
Q

Which IV forms of iron have a BBW for anaphylactic reaction?

A

Iron dextran

Iron sucrose

37
Q

Which IV forms of iron have an increased risk of hypersensitivity?

A

Ferumoxytol
Ferric carboxymaltose
Sodium Ferric gluconate

38
Q

How do we monitor oral iron therapy?

A

Reticulocyte increase w/in days
Hgb rises in 2-3 weeks
Hgb normal in 2 months or less
Total duration often 6-12 months

39
Q

How do we monitor IV iron therapy?

A

Monitored w/in 1 week: ferritin, transferrin, hgb, hct

Monitored monthly: iron, ferritin

40
Q

From what foods does B12 come from?

A 
Meat
Fish
Poultry
Dairy
Fortified cereals
41
Q

From what foods does Folic Acid come from?

A 
Enriched foods
Green leafy
Vegetables
Citrus fruits
Yeast
Mushrooms
Dairy products
Animal organs
42
Q

What two vitamins are reduced in macrocytic anemias?

A

B12

Folic acid

43
Q

What drugs reduce B12 absorption?

A

PPIs
H2RAs
Metformin

44
Q

What drugs reduce folic acid?

A 
AZA
6-MP
5-FU
Hydroxyurea
Zidovudine
MTX
Pentamidine
Trimethoprim
Triamterene
Phenytoin
Phenobarb
Primidone
45
Q

What are the initial s/sx of neurologic B12 deficiency?

A

Bilateral paraesthesia in extremities
Loss of perception to surrounding objects
Loss of vibratory sensation

46
Q

What are the severe s/sx of neurologic B12 deficiency?

A

Lack of muscle control
Dementia
Psychosis
Vision loss

47
Q

What are the s/sx of folic acid deficiency?

A

No additional s/sx beyond general s/sx of anemia

48
Q

What labs are observed for macrocytic anemias?

A 
Folic acid
B12
\+/- Homocysteine
\+/- Methylmalonic acid (MMA)
\+/- Schillings test
49
Q

How is B12 deficiency diagnosed?

A

Decreased retic’s
Increased MMA
Increased Homocysteine
+ Schilling’s

50
Q

What is the treatment for B12 deficiency?

A

Oral preferred
IV
Nasal

51
Q

When are higher doses of B12 considered?

A

Pernicious anemia or lack of ilium

52
Q

When is IV B12 considered?

A

Non-compliant
Unable to take oral
Neurologic involvement

53
Q

What drugs interact with B12?

A

PPIs
H2RAs
Metformin

54
Q

What is the monitoring of B12 treatment?

A 
Sx improvement w/in days
Increased retic w/in 5 days
Hgb rises increase 1 week
Hgb normalizes w/in 2 months or less
B12 1-2 months
55
Q

What is the diagnosis of Folic acid deficiency?

A

Rule out B12
Increased MCV
Decreased folate
Increased homocysteine

56
Q

What is monitoring used in folic acid therapy?

A

Reticulocytes increase w/in 5-7 days
Hgb rises within 2 weeks
Hgb normalizes w/in 2 months

57
Q

What are the types of anemia of inflammation?

A

Anemia of chronic disease
Anemia of critical illness
Hemolysis
Blood loss

58
Q

What causes chronic disease in normocytic anemias?

A 
Chronic infection
Inflammatory disorders
CHF
ESRD
HIV
59
Q

What causes critical illness in normocytic anemias?

A 
Frequent blood samples
Sepsis
Active bleeding
Immune mediated iron deficiency
Increased metabolic demands
60
Q

What is the pathophysiology of normocytic anemias?

A 
Pro-inflammatory cytokines released
Blunted EPO response
Impaired erythroid proliferation
Disturbance of iron homeostasis
Shorted RBC life span
61
Q

What labs are taken in normocytic anemias?

A 
LDH
Coombs
Haptoglobin
Fractionated bilirubin
Stool guiac 
Folic acid
B12
Iron studies
62
Q

How are normocytic anemias tested for?

A

Colonoscopy

Esophagogastroduodenoscopy

63
Q

What diseases must be ruled out?

A

Rule out blood loss
Rule out iron deficiency
Rule out B12 deficiency
Rule out folic acid deficiency

64
Q

How are labs altered in normocytic anemia?

A 
Decreased hgb
Decreased iron
TIBC decreased
Ferritin increased/normal
Transferrin saturation decreased
Transferrin decreased/normal
65
Q

What is the main treatment of normocytic anemia?

A

Treat the underlying cause

66
Q

What is an alternative treatment to normocytic anemia?

A 
Blood transfusions
Vitamins
Iron
B12
Folic acid
ESA?
67
Q

When do we give blood transfusions?

A

Hgb < 7

68
Q

What is considered in elderly treatment as an alteration to therapy in anemias?

A

Lower dose iron d/t GI effects

Heme/Onc (20 decks)

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