Anticoagulation & Blood Disorders: Anemia

Question 1

Anemia is the….

Answer 1

decrease in hemoglobin (Hgb) and hematocrit (Hct) below normal range for age and gender

Question 2

Symptoms of Anemia

Answer 2

fatigue
weakness
SOB
exercise intolerance
headache
dizzines
anorexia
pallor

Question 3

What can develop with iron deficiency anemia

Answer 3

Glossitis = inflammed/sore tongue
koilonychias = thin,concave, spoon shaped nails
pica = craving/eating non foods such as chalk or clay

Question 4

Patients with vitamin B12 deficiency can present with

Answer 4

neurologic symptoms such as peripheral neuropathies, visual disturbances and/or psychiatric symptoms

Question 5

MCV < 80 likely what type of anemia cause

Answer 5

Iron deficiency

microcytic = RBC smaller than normal

Question 6

MCV > 100 likely what type of anemia cause

Answer 6

likely caused by vitamin B12 or folate deficiency

microcytic = RBC larger than normal

Question 7

What is the most common nutritional deficiency?

Answer 7

iron deficiency

common causes: low iron intake, blood loss, decreased iron absorption, decreased iron requirements

Question 8

Lab findings for iron deficiency anemia

Answer 8

Low Hgb, MCV < 80, serum iron, ferritin and TSAT
inc TIBC

Question 9

common iron dosing for iron therapy?

Answer 9

1 tablet po QD

Question 10

differences in iron supplements?

Answer 10

amount of elemental

the more elemental iron, maybe worse side effects

Sulfate more elemental than gluconate

Question 11

Iron overdose antidote

Answer 11

deferoxamine (Desferal)

Question 12

Drug interactions with oral iron

Answer 12

take 2hrs before or 4 hrs after antacids, dont take with H2RA/ppi since affect pH for 24hrs

Separate from quinolones/tetracylines/bisphosphates/levo due to dec absorption

Taking with Vitamin C can inc absorption

Question 13

IV iron restricted for…

Answer 13

CKD on hemodialysis
pts who cant tolerate oral iron
Severe anemia or losing iron too fast for oral replacement
alternative when blood transfusions not accepted

Question 14

Iron Dextran and Ferumoxytol Box warning

Answer 14

serious, sometimes fatal anaphylactic reactions occur
Have to do test dose, but even with can have allergic reaction

Question 15

Pernicious anemia occurs due to lack of

Answer 15

intrinsic factor
requires parenteral vitamin B12 replacement for life

Question 16

1st line B12 supplement

Answer 16

injections are recommended

Question 17

Long term use of what can decrease absorption of B12

Answer 17

metformin, H2RAs and PPIs

Question 18

Deficiency of EPO causes anemia of….

Answer 18

chronic kidney disease

Question 19

Treatments for anemia of CKD

Answer 19

iron therapy and ESA

Question 20

KDIGO guidelines for iron therapy

Answer 20

in both non-HD and HD patients

TSAT < 30% and Ferritin lvls < 500ng/ml

Question 21

Epoetin alfa Boxed warnings

Answer 21

increased risk of death, MI, stroke, VTE, thrombosis

use lowest effective dose

Dont use in cancer if intended outcome is cure, shortened survival and inc tumor progression in clinical trials

Question 22

Epoetin alfa dosing CKD

Answer 22

50-100units/kg 3X/week

start when Hgb < 10 and stop when > 11

Question 23

Epoetin alfa dosing in cancer (taking chemo)

Answer 23

150units/kg 3X/week or 40,000 units weekly

start when Hgb < 10, and atleast 2 months of chemo expectedt

Question 24

how to titrate epoetin alfa

Answer 24

do it every 4 weeks, takes awhile to see results of dose change

Question 25

Immune mediated drug-induced hemolytic anemia

Answer 25

development of antibodies that attack RBC

will be positive direct Coombs test

Question 26

G6PD deficiency hemolysis

Answer 26

result in negative direct Coombs Test

G6PD enzyme protects RBCs from oxidant injury, but without sufficient lvls of G6PD then RBCs hemolyze 24-72hrs after exposure to oxidative stress

avoid high risk medications

only real solution is to discontinue the offending agent