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CRP- Cardiology > Antianemics > Flashcards

Antianemics Flashcards

1
Q

What is a microcytic anemia?

A

MCV (mean corpuscular volume)

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2
Q

What is a macrocytic anemia?

A

MCV >99= large RBCs due to accumulation of precursors for DNA synthesis (which require B12 or folate to carry them through maturation).
*So you will treat a macrocytic anemia with either B12 or folic acid.

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3
Q

How much total iron is in the body?

A

4 grams

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4
Q

Is iron essential to all cells?

A

YES and 90% is recycled.

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5
Q

Is iron ever free?

A

RARELY. It is usually bound to specific proteins bc it is toxic otherwise.

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6
Q

How is iron lost?

A

It doesn’t have a good mechanism for loss, so it is only lost by exfoliation in the skin or bleeding.

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7
Q

What are the major causes of iron deficiency anemia?

A

In men due to peptic ulcer and menorrhagia in women.

Also malnutrition, malabsorption, and gastrectomy.

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8
Q

What is the major storage site for iron?

A

the liver as apoferritin.

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9
Q

What happens if you need more iron?

A

your body will absorb more.

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10
Q

What happens if you have enough of iron?

A

your body will not absorb anymore and will be passed along.

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11
Q

How is iron transported in the blood?

A

via transferrin.

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12
Q

What is the total iron binding capacity?

A

really synonymous with the amount of transferrin available in the blood.

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13
Q

What are the iron binding proteins in the body?

A
  • hemoglobin= 50-66%
  • reticuloendothelial cells (macrophages)= 27% (ferritin and hemosiderin).
  • myoglobin= 3-13%
  • cytochromes= 2%
  • transferrin= 1%
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14
Q

What is the normal saturation % of transferrin?

A

20-35%

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15
Q

What will the TIBC be if you have an iron deficiency?

A

High, because there is little iron around, you have many open sites on transferrin.

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16
Q

Will your hematocrit and hemoglobin be normal in slight iron deficiency?

A

YES

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17
Q

What are the symptoms of iron deficiency?

A

tired and fatigued

18
Q

Will your hematocrit (%RBCs) be decreased if you have an iron deficiency ERYTHROPOIESIS?

A

YES, TIBC saturation will be low and TIBC will be high

19
Q

**Will your hematocrit be decrease if you have an iron deficiency ANEMIA?

A

YES along with microcytosis, hypochromia, irregular cell shapes, and sizes.
TIBC saturatoin= low
TIBC= high
You will also have sever fatigue, dizziness, increased HR, dyspnea, CHF and palpitations.

20
Q

What is the treatment for microcytic anemia?

A

Restore hemoglobin and RBC production via FERROUS SULFATE, thus increasing iron stores.

21
Q

** What is iron dextran?

A

iron supplement administered IM or IV as a large bolus.

22
Q

** What will acute iron toxicity do to you?

A

shock, hypovolemia, heart/liver/renal failure due to free iron, also acidosis, coma, or even death.
TIBC>100%

23
Q

** How do you treat iron toxicity?

test question

A

deferoxamine= an iron chelator that binds to iron.
Also use emesis, lavage, and sodium-bicarb.
*contraindicated in pregnancy and renal dysfunction.

24
Q

** What is folic acid?

A

essential for 1-carbon metabolism of DNA and it is needed in pregnancy to inhibit neural tube disorders in fetus.

25
Q

What will a deficiency in folic acid lead to?

A

a deficiency in DNA synthesis.

26
Q

What is a MEGALOblastic anemia?

A

any deficiency that involves lack of folic acid or B12, and thus a megaloblastic change in all rapidly dividing cells (i.e. these cells look large).

27
Q

How does a macrocytic anemia differ from a megaloblastic anemia?

A

macrocytic does not involve folic acid or vitamin B12 deficiency. Rather alcohol, liver disease, and the drug 5-FU can cause this.

28
Q

What does methotrexate and trimethoprim do?

A

inhibit dihydrofolate reductase, thus leading to a folate deficiency

29
Q

Will methylmalonic acid change in a folate deficiency?

A

NO it will be normal.

30
Q

Will methylmalonic acid change in a B12 deficiency?

A

YES it will go up because it requires B12 to convert it to succinyl-CoA

31
Q

How do you treat folate deficiency?

A

Eat leafy green veggies :)

32
Q

** What would happen if you treat a vitamin B12 deficiency with folate; aka you thought you had a folate deficiency, so you treated with folate?
(BOARD QUESTION)

A

you will correct the NONneurologic symptoms of B12 deficiency and treat the anemia, but you will still have the neurologic symptoms!!!

33
Q

***Why do we need vitamin B12 (hydroxocobalamin)?

A

it is needed for FH4 (TH4) production and used to generate deoxythymidylate (dTMP) for DNA synthesis and also needed for methionine/myelin synthesis (hence neurological).

34
Q

What will pernicious anemia do?

A

inhibits the parietal cells of the stomach from secreting intrinsic factor, which is needed for B12 absorption in the ileum. Hence, you will get a B12 deficiency.

35
Q

Will B12 deficiency cause myelin degeneration and memory loss?

A

YES. Folate deficiency will NOT though.

36
Q

How do you test for B12 deficiency/pernicious anemia?

A

Schilling test

37
Q

Will oral supplements of vitamin B12 often help if you have a deficiency?

A

NO, because it is mostly due to a malabsorption issue, so even if you take more, you won’t be able to absorb it. So you must get it IM or IV.
*Remember, this takes a LONG time to develop because the liver has at least a year’s worth of B12 stores.

38
Q

What important condition will lead to a decrease in erythropoietin (EPO)?

A

anemia of chronic disease (renal failure) because the kidneys are what produce EPO. Be careful when giving EPO though because too much can cause thrombosis :(

39
Q

**What is Filgrastim (G-CSF)?

board question

A
  • increases production of neutrophils and enhances mobilization of hematopoietic stem cells into the blood.
  • used in recovery from chemo/AIDS/transplantation immunosuppression.
40
Q

What is Sargramostim?

A

stimulates growth of stem cells into granulocytes and macrophages.

41
Q

What is Oprelvekin (IL-11)?

A

stimulates growth of megakaryocytes and increases number of platelets.

CRP- Cardiology (49 decks)

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