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NAPLEX 2023 > Chapter 35: Anemia > Flashcards

Chapter 35: Anemia Flashcards

1
Q

Anemia is a decrease in ___ & ___ concentrations below the normal range

A

Hgb & Hct

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2
Q

Another name for immature RBCs

A

reticulocytes

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3
Q

Anemia can result from:

A

nutritional deficiencies (e.g., iron, folate, vitamin B12) or it can occur as a complication of another medical disorder, such as CKD or malignancy

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4
Q

Classic symptoms of anemia

A

fatigue, weakness, SOB, exercise intolerance, HA, dizziness, anorexia and/or pallor

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5
Q

Which signs/symptoms can occur with iron deficiency anemia

A

Glossitis (an inflamed, sore tongue), koilonychias (thin, concave, spoon-shaped nails) or pica (craving and eating non-foods)

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6
Q

Vitamin B12 deficiency can present with

A

peripheral neuropathies

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7
Q

A low MCV means that RBCs are ____ than normal, which is called ___ anemia

A

smaller
microcytic

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8
Q

A high MCV means that RBCs are ____ than normal, which is called ___ anemia

A

larger
macrocytic

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9
Q

Likely cause of MCV < 80 fL anemia

A

iron deficiency

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10
Q

MCV 80-100 fL (normocytic) anemia likely cause

A

acute blood loss, malignancy, CKD, bone marrow failure (aplastic anemia), hemolysis

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11
Q

Likely cause of MCV > 100 fL anemia

A

B12 or folate deficiency

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12
Q

A reticulocyte count measures

A

production of RBCs

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13
Q

Reticulocyte count is low in

A

untreated anemia due to iron, folate or B12 deficiency and with bone marrow suppression

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14
Q

The most common nutritional deficiency in the US

A

iron deficiency

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15
Q

Causes of iron deficiency

A
  • Iron-poor diets (e.g., vegetarian)
  • Blood loss
  • decreased iron absorption (High gastric pH, GI diseases)
  • Pregnancy, lactation
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16
Q

Lab findings in iron deficiency anemia

A
  • ↓ Hgb, MCV < 80 fL, ↓ RBC production (low reticulocyte count)
  • ↓ serum iron, ferritin and TSAT
  • ↑ TIBC
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17
Q

Recommended dose range of oral iron for treating iron deficiency anemia

A

100-200 mg elemental iron per day

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18
Q

How should oral iron be taken

A

on an empty stomach

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19
Q

Oral iron should be avoided with

A

H2RAs and PPIs, separate from antacids

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20
Q

Goal of oral iron therapy

A

↑ in serum Hgb by 1 g/dL every 2-3 weeks; continue treatment for 3-6 months after anemia has resolved until iron stores return to normal

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21
Q

% elemental iron in oral products:

  • Ferrous gluconate = x%
  • Ferrous sulfate = x%
  • Ferrous sulfate, dried = x%
  • Ferrous fumarate = x%
  • Carbonyl iron, polysaccharide iron complex, ferric maltol = x%
A
  • Ferrous gluconate = 12%
  • Ferrous sulfate = 20%
  • Ferrous sulfate, dried = 30%
  • Ferrous fumarate = 33%
  • Carbonyl iron, polysaccharide iron complex, ferric maltol = 100%
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22
Q

Parenteral iron is primarily used in

A

dialysis

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23
Q

Ferrous sulfate dosing

A

325 mg (65 mg elemental iron) PO daily to TID

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24
Q

Ferrous sulfate, dried 160 mg has how much elemental iron

A

50 mg

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25
Q

Oral iron BW

A

Accidental overdose of iron-containing products is a leading cause of fatal poisoning in children under 6; in the case of accidental OD, go to the ED or call a poison control center immediately (even if asymptomatic)

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26
Q

Oral iron SE

A

Constipation (dose-related), dark and tarry stools

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27
Q

Antidote for iron overdose

A

deferoxamine (Desferal)

28
Q

Which drugs decrease iron absorption

A

Antacids, H2RAs, and PPIs

29
Q

Iron should be separated from the following meds since it can decrease their absorption:

A

Quinolone & tetracycline antibiotics
Bisphosphonates
Levothyroxine

30
Q

Which supplement can increase the absorption of iron

A

Vitamin C (Giving iron with ascorbic acid may enhance the absorption to a minimal extent)

31
Q

IV iron is restricted to which patients:

A
  • CKD on hemodialysis (most common use of IV iron)
  • CKD receiving erythropoiesis-stimulating agents (ESAs)
  • Unable to tolerate oral iron or failure of oral therapy
  • Religious reasons
32
Q

Iron sucrose brand name

A

Venofer

33
Q

Ferumoxytol brand name

A

Feraheme

34
Q

IV iron BW

A

Serious and sometimes fatal anaphylactic reactions with iron dextran or ferumoxytol; all patients receiving iron dextran should be given a test dose prior to the first full therapeutic dose

35
Q

Triferic is only indicated for iron replacement in patients with hemodialysis-dependent CKD; it should be added to the ____ concentrate of the hemodialysate for pts receiving hemodialysis

A

bicarbonate

36
Q

____ anemia is the most common cause of vitamin B12 deficiency & occurs due to a lack of _____

A

Pernicious anemia
intrinsic factor

IF is required for B12 absorption in the small intestine

37
Q

Pernicious anemia can be diagnosed using the ____ test and requires lifelong parenteral _______

A

positive autoantibody test to Intrinsic factor (IF)
(replaced Schilling test)

vitamin B12 replacement

38
Q

Other causes of macrocytic anemia besides B12 and folate deficiency

A

alcoholism, poor nutrition, GI disorders (e.g., Crohn’s disease, celiac disease)

39
Q

Long-term use (≥ 2 years) of ___, ____ or ___ can decrease the absorption of vitamin B12

A

Metformin, H2RAs, PPIs

40
Q

b12 deficiency can cause

A

serious neurologic dysfunction - cognitive, peripheral neuropathies.
if undiagnosed for > 3 months –> irreversible damage

41
Q

Folic acid deficiency causes

A

ulcerations of the tongue and oral mucosa

42
Q

Diagnosis of macrocytic anemia

A

Low Hgb and high MCV

43
Q

First-line treatment for macrocytic anemia

A

B12 injections (caynocobalamin) - IM or deep SC

with severe deficiency or neurologic symptoms

44
Q

How is Cyanocobalamin nasal solution (Nascobal) used

A

once nostril once weekly

45
Q

EPO is a hormone produced by the kidneys that stimulates the ____ to produce ____

A

bone marrow
RBCs

46
Q

Deficiency of EPO causes anemia of

A

CKD

47
Q

Treatment for anemia of CKD

A

Iron therapy and ESAs

48
Q

What is first-line for hemodialysis patients

A

IV iron

49
Q

KDIGO guidelines recommend iron if TSAT ≤ ____ and ferritin is ≤ ____
KDOQI guidelines recommend iron if TSAT ≤ ____ and ferritin is ≤ ____ (non-HD) and ____ (HD)

A

KDIGO: 30% and 500 ng/mL (both HD and non-HD)
KDOQI: 20% and 100 ng/mL (non-HD) and 200 ng/mL (HD)

50
Q

ESAs help maintain ___ levels & reduce the need for _____, but they are ineffective if iron stores are low

A

Hgb
Blood transfusions

51
Q

Epoetin alfa brand name

A

Epogen, Procrit

52
Q

Darbepoetin brand name

A

Aranesp

53
Q

How many times per week is Epoetin alfa given in CKD

A

3x/week

54
Q

Epoetin alfa is initiated when Hgb < __ g/dL in CKD and cancer patients

A

10

55
Q

Epoetin alfa dose should be decreased or interrupted when Hgb approaches or exceeds __ g/dL (CKD or HD)

A

11

56
Q

Darbepoetin for CKD is given IV or SC how many times per week (for HD)

A

once weekly (or q2weeks)

non-HD is every 4 weeks

57
Q

ESA boxed warnings

A

Increases risk of death, MI, stroke, VTE, thrombosis
CKD: increased risk of death when Hgb level > 11 g/dL
Cancer: not indicated when the anticipated outcome is cure

58
Q

ESAs can cause what side effects

A

Hypertension, arthralgia

59
Q

ESA monitoring

A

Hgb, Hct, TSAT, serum ferritin, BP

60
Q

ESA’s recommended route for HD patients

A

IV

61
Q

How should ESAs be stored

A

in the refrigerator; do not shake

62
Q

The darbepoietin half-life is __-fold longer than epoetin alfa

A

3-fold (can be given once weekly for this reason)

63
Q

Causes of hemolytic anemia

A

Drug-induced or G6PD deficiency

64
Q

Which test is used to detect antibodies that are stuck to the surface of RBCs in hemolytic anemia

A

Direct Coombs test

65
Q

what is the basic role of G6PD

A

protect RBCs from harmful substances - that’s why deficiency is dangerous with certain drugs

66
Q

Most people with G6PD deficiency should be instructed to avoid which high-risk medications

A
  • Cephalosporins
  • Dapsone+
  • Isoniazid
  • Levodopa
  • Methyldopa
  • Methylene blue+
  • Nitrofurantoin+
  • Pegloticase+
  • Penicillins
  • Primaquine+
  • Quinidine
  • Quinine
  • Rasburicase+
  • Rifampin
  • Sulfonamides+
    + avoid in G6PD deficiency

NAPLEX 2023 (88 decks)

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