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Heme Onc Oakland TextBook > Approach to Anemia > Flashcards

Approach to Anemia Flashcards

1
Q

What are the big main categorical causes of anemia? (4)

A
  1. Increased RBC Destruction
  2. Decreased RBC production
  3. Increased RBC loss
  4. Sequestration
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2
Q

What’s is high RDW called? and what does it mean? What conditions can it be seen in? (2)

A
  • Anisocytosis
  • Increase in the range of red cells width and it is seen in stress eythropoiesis.
  • Can be seen in iron deficiency and hemolysis.
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3
Q

What’s retic count like in the following conditions:

  1. Blood loss
  2. Hemolysis
  3. Sequestration
A

Elevated in all

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4
Q

What are examples of causes of iron deficiency? (3)

A
  1. Decreased dietary intake
  2. Chronic blood loss
  3. Anatomical cause (short gut syndrome)
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5
Q

What are causes of microcytic anemia? (5)

A
  1. Iron deficiency
  2. Hemoglobinopathies (Eg. Thalassemia or Hgb E)
  3. Chronic diseases/infection
  4. lead toxicity
  5. sideroblastic anemia
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6
Q

What are causes of normocytic anemia? (10)

A
  1. Early iron deficiency
  2. Red cell aplasia
  3. Malignancy
  4. Infection
  5. Renal failure (could be microcytosis too)
  6. Hypersplenism
  7. Drugs
  8. Acute blood loss
  9. Hemolysis (enzyme deficiency, membrane defect)
  10. Aplastic anemia (can be macrocytosis)
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7
Q

What are causes of macrocytic anemia? (9)

A
  1. Normal newborn
  2. Reticulocytosis
  3. Post splenectomy
  4. Liver disease
  5. Aplastic Anemia and marrow failure syndromes
  6. Hypothyroidism
  7. Down syndrome
  8. Syndromes with elevated HgB F
  9. Megalobolastic anemia.
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8
Q

What happens to MCV post splenectomy?

A

Gets bigger; can see macrocytosis

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9
Q

What happens to iron indicies in IDA? (4)

A

TIBC: Elevated
Serum iron: Low
Ferritin: Low
Transferrin saturation: Low

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10
Q

What medications can lead to iron deficiency? (2)

A

Antacids

Histamine-2 Blockers

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11
Q

How does lead toxicity cause microcytosis?

A

Lead actually impairs iron absorption which in turns cause IDA and microcytosis

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12
Q

What are examples of chronic disorders that impair iron absorption? (3)

A
  1. SLE
  2. PUD (peptic ulcer disease)
  3. IBD (UC and crohn’s)
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13
Q

What are the indications for oral iron challenge in IDA?

A

Anytime a poor response to oral iron is being questioned.

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14
Q

How to conduct an oral iron challenge?

A
  1. Draw serum iron
  2. Give a dose of 3mg/Kg or elemental iron orally
  3. Draw another serum iron level 30-60 min post.

You would expect an increase in serum iron by at least 100mcg/dL if absorption is adequate

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15
Q

Name different parental iron preparations that are currently available in the US? (4)

A
  1. Ferric gluconate
  2. Iron sucrose
  3. Ferumoxytol
  4. Ferric carboxymaltose
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16
Q

What are the advantages of the newer parentral iron preparations over ferric gluconate and iron surcose?

A

Total dose replacement can be done in a very short and single infusion

17
Q

What are some of the concerns with iron dextran? (2)

A
  1. Severe allergic reactions can occur with iron dextran and therefore LMW product should be used.
  2. mild/moderate arthralgias the day after infusion
18
Q

What precautions should be undertaken when infusing iron dextran? (2)

A
  1. A test dose of 10-25mg should be given prior to the first dose.
  2. If tolerated, the patient should be observed for 30-60 min during the first infusion.
19
Q

What medical condition is considered to be a contraindication to the use of iron dextran? (1)

A

Rheumatoid Arthritis.

20
Q

What are the cutoffs for the different degrees of Anemia? (3)

A
  1. Mild: Hgb <10
  2. Mod: Hgb 7-10
  3. Severe: HgB <7
21
Q

What’s the treatment dose of oral iron?

A

4-6mg/Kg/Day

22
Q

What are some indications for EPO? (6)

A
  1. End-stage renal disease
  2. Anemia of prematurity
  3. Anemia of chronic disease
  4. Anemia associated with the treatment of AIDS
  5. Autologous blood donation.
  6. Religious factors in patients who are receiving chemo
23
Q

What is the most common SE with the use of EPO?

A
  1. Hypertension
24
Q

What’s he starting dose of EPO?

A

Typically 150u/Kg three times a week

Response is usually seen within 1-2 wks

Patients should be taking iron supplements too

Heme Onc Oakland TextBook (2 decks)

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