Ch 57: Anemia

Question 1

anemia sx

Answer 1

fatigue, weakness, SOB, exercise intolerance, HA, dizziness, anorexia, +/- pallor

Question 2

glossitis

Answer 2

inflamed, sore tongue may occur in iron deficiency anemia

Question 3

pica

Answer 3

craving and eating non-foods such as chalk or clay may occur in iron deficiency anemia

Question 4

kollonychias

Answer 4

thin, concave, spoon-shaped nails may occur in iron deficiency anemia

Question 5

MCV

Answer 5

mean corpuscular vol, reflects size of RBCs. if low - microcytic anemia. if high - macrocytic anemia.

Question 6

microcytic anemia cause

Answer 6

iron deficiency, most common in US

Question 7

macrocytic anemia cause

Answer 7

vit b12 (commonly lack of intrinsic factor) or folate deficiency, aka pernicious anemia. also: alcoholism, poor nutrition, GI disorders, preg. long term use of (2+ yrs): metformin, H2RAs, PPIs.

Question 8

normocytic anemia cause

Answer 8

CKD (commonly d/t deficiency in erythropoietin EPO), malignancy, acute blood loss (surgery or trauma), bone marrow failure (aplastic anemia), hemolysis

Question 9

reticulocyte count

Answer 9

measure of RBC production, immature RBC count

Question 10

heme iron

Answer 10

meat and seafood, readily absorbed

Question 11

non-heme iron

Answer 11

nuts, beans, veg, fortified grains, not as readily absorbed - depends on gastric pH and other foods being consumed

Question 12

ppx iron deficiency

Answer 12

low dose fe supplement for all preg women d/t higher requirement in preg. hormonal contraception for women may have less bleeding and thus lose less iron

Question 13

IDA

Answer 13

iron deficient anemia, low hgb, low MCV, low retic count, low serum fe/ferritin/TSAT, high TIBC (iron sites avail to bind)

Question 14

IDA tx

Answer 14

100-200 mg PO elemental iron per day on empty stomach, high gastric pH (no PPIs/H2RAs), separate from antacids. later in therapy can rec SR or enteric forms with less GI upset but not rec 1st line.

Question 15

IDA tx goal

Answer 15

inc hgb by 1 g/dl q2-3wks, continue tx for 3-6 mo after anemia has resolved until iron stores are back to normal

Question 16

% elemental iron: ferrous gluconate, sulfate, sulfate dried, fumurate, carbonyl iron, polysaccharide iron complex

Answer 16

gluconate 12 (most common). sulfate 20. sulfate dried 30 (ER). fumurate 33. 100% for the last 2.

Question 17

ferrous sulfate & other PO irons - dose, BBW, ADRs

Answer 17

325 mg (65 mg elemental) PO QD-TID. BBW: accidental OD of fe-containing products can be fatal poisoning in children, if occurs –> poison control center or ED immed even if asx. ADRs: nausea, stomach upset, dose-related constipation (may provide laxative), dark and tarry stools

Question 18

deferoxamine - brand, indication

Answer 18

desferal, antidote for iron OD

Question 19

vitamin C

Answer 19

may inc absorption of iron by providing acidic env. provide 200 mg for minimal effect.

Question 20

indications for IV fe

Answer 20

1) pts with CKD on HD, 2) in combo with ESAs in CKD, 3) unable to tolerate PO iron or failure of PO tx, 4) losing fe too fast for PO intake, 5) as alt when blood transfusions are not accepted by pt (religion)

Question 21

common fe IV products, BBW, ADRs

Answer 21

Iron dextran (INFeD), sodium ferric gluconate (Ferrlecit), iron sucrose (Venofer), Ferumoxytol (Feraheme). BBW: anaphylactic rxns - all pts receiving dextran should have test dose. ADRs: all IV agents have risk of hypersens.

Question 22

Triferic - generic, indication

Answer 22

ferric pyrophosphate citrate. only indicated for pts on HD CKD, add to bicarb conc of HD.

Question 23

vit b12 deficiency

Answer 23

causes serious neuro dysfunction, may be irreversible

Question 24

vit b12 - brand, forms

Answer 24

nascobal is nasal. cyanocobalamin. injection (IM or SC), lozenge, tabs, SL, nasal soln.

Question 25

macrocytic anemia tx

Answer 25

initially b12 injections, then PO supplementation. if severe deficiency or neuro sx, b12 injections are 1st line.

Question 26

anemia of CKD tx

Answer 26

iron tx and ESAs to maintain hgb levels and reduce need for blood transfusions. IV iron first line for HD pts. PO iron first line for non-HD pts.

Question 27

ESA pt counseling

Answer 27

do not shake. rotate injection sites.

Question 28

aplastic anemia and tx

Answer 28

bone marrow fails to make enough RBCs, WBCs, and plts. tx may include immunosuppressants, blood transfusions, or stem cell transplant.

Question 29

Promacta - generic, MOA, indication

Answer 29

Eltrombopag. thrombopoietin nonpeptide agonist. increases plt counts. approved for tx of severe aplastic anemia in pts unresponsive to immunosuppressants.

Question 30

direct coombs test

Answer 30

detects ab that are stuck to the surface of RBCs, which may cause hemolytic anemia

Question 31

glucose-6-phosphate dehydrogenase (G6PD)

Answer 31

x-linked inherited disorder common in ethnicities (Asian, African, Mediterranean, Middle Eastern). do not need tx, avoid high risk meds and triggers. G6PD protects RBCs from harm, in deficiency RBCs hemolyze after exposure to oxidative stress. self-limiting sx usually.

Question 32

Epoetin Alfa - brand, indication, freq

Answer 32

procrit, epogen. CKD: initiate when hgb <10. dec or interrupt dose when hgb approaches or exceeds 11 (CKD on HD) or 10 (CKC no HD). Cancer: initiate when hgb <10. do not inc dose more freq than once q4wks.

Question 33

Darbepoetin - brand, freq/t1/2

Answer 33

aranesp. CKD, cancer. t1/2 is 3x longer than epo so give wkly instead of 3x/wk.

Question 34

ESA BBW, warnings, monitoring, notes

Answer 34

BBW: use lowest effective dose to reduce need for blood transfusions. CKD: inc risk of death, serious CV events, stroke when hgb >11. cancer: shortened overall survival +/- inc risk of tumor progression or recurrence, not indicated when anticipated outcome is cure. Perisurgery: DVT ppx d/t inc risk of DVT. warnings: HTN. mointor: h/h, TSAT, fe, BP. IV rec f m HD. store in fridge.