Anticoagulation & Blood Disorders: Anemia Flashcards
Anemia is the….
decrease in hemoglobin (Hgb) and hematocrit (Hct) below normal range for age and gender
Symptoms of Anemia
fatigue
weakness
SOB
exercise intolerance
headache
dizzines
anorexia
pallor
What can develop with iron deficiency anemia
Glossitis = inflammed/sore tongue
koilonychias = thin,concave, spoon shaped nails
pica = craving/eating non foods such as chalk or clay
Patients with vitamin B12 deficiency can present with
neurologic symptoms such as peripheral neuropathies, visual disturbances and/or psychiatric symptoms
MCV < 80 likely what type of anemia cause
Iron deficiency
microcytic = RBC smaller than normal
MCV > 100 likely what type of anemia cause
likely caused by vitamin B12 or folate deficiency
microcytic = RBC larger than normal
What is the most common nutritional deficiency?
iron deficiency
common causes: low iron intake, blood loss, decreased iron absorption, decreased iron requirements
Lab findings for iron deficiency anemia
Low Hgb, MCV < 80, serum iron, ferritin and TSAT
inc TIBC
common iron dosing for iron therapy?
1 tablet po QD
differences in iron supplements?
amount of elemental
the more elemental iron, maybe worse side effects
Sulfate more elemental than gluconate
Iron overdose antidote
deferoxamine (Desferal)
Drug interactions with oral iron
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
IV iron restricted for…
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
Iron Dextran and Ferumoxytol Box warning
serious, sometimes fatal anaphylactic reactions occur
Have to do test dose, but even with can have allergic reaction
Pernicious anemia occurs due to lack of
intrinsic factor
requires parenteral vitamin B12 replacement for life
1st line B12 supplement
injections are recommended
Long term use of what can decrease absorption of B12
metformin, H2RAs and PPIs
Deficiency of EPO causes anemia of….
chronic kidney disease
Treatments for anemia of CKD
iron therapy and ESA
KDIGO guidelines for iron therapy
in both non-HD and HD patients
TSAT < 30% and Ferritin lvls < 500ng/ml
Epoetin alfa Boxed warnings
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
Epoetin alfa dosing CKD
50-100units/kg 3X/week
start when Hgb < 10 and stop when > 11
Epoetin alfa dosing in cancer (taking chemo)
150units/kg 3X/week or 40,000 units weekly
start when Hgb < 10, and atleast 2 months of chemo expectedt
how to titrate epoetin alfa
do it every 4 weeks, takes awhile to see results of dose change
Immune mediated drug-induced hemolytic anemia
development of antibodies that attack RBC
will be positive direct Coombs test
G6PD deficiency hemolysis
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
