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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
Oral iron BW
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)
26
Oral iron SE
Constipation (dose-related), dark and tarry stools
27
Antidote for iron overdose
deferoxamine (Desferal)
28
Which drugs decrease iron absorption
Antacids, H2RAs, and PPIs
29
Iron should be separated from the following meds since it can decrease their absorption:
Quinolone & tetracycline antibiotics Bisphosphonates Levothyroxine
30
Which supplement can increase the absorption of iron
Vitamin C (Giving iron with ascorbic acid may enhance the absorption to a minimal extent)
31
IV iron is restricted to which patients:
- 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
Iron sucrose brand name
Venofer
33
Ferumoxytol brand name
Feraheme
34
IV iron BW
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
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
bicarbonate
36
____ anemia is the most common cause of vitamin B12 deficiency & occurs due to a lack of _____
Pernicious anemia intrinsic factor | IF is required for B12 absorption in the small intestine
37
Pernicious anemia can be diagnosed using the ____ test and requires lifelong parenteral _______
positive autoantibody test to Intrinsic factor (IF) (replaced Schilling test) | vitamin B12 replacement
38
Other causes of macrocytic anemia besides B12 and folate deficiency
alcoholism, poor nutrition, GI disorders (e.g., Crohn’s disease, celiac disease)
39
Long-term use (≥ 2 years) of ___, ____ or ___ can decrease the absorption of vitamin B12
Metformin, H2RAs, PPIs
40
b12 deficiency can cause
serious neurologic dysfunction - cognitive, peripheral neuropathies. if undiagnosed for > 3 months --> irreversible damage
41
Folic acid deficiency causes
ulcerations of the tongue and oral mucosa
42
Diagnosis of macrocytic anemia
Low Hgb and high MCV
43
First-line treatment for macrocytic anemia
B12 injections (caynocobalamin) - IM or deep SC | with severe deficiency or neurologic symptoms
44
How is Cyanocobalamin nasal solution (Nascobal) used
once nostril once weekly
45
EPO is a hormone produced by the kidneys that stimulates the ____ to produce ____
bone marrow RBCs
46
Deficiency of EPO causes anemia of
CKD
47
Treatment for anemia of CKD
Iron therapy and ESAs
48
What is first-line for hemodialysis patients
IV iron
49
KDIGO guidelines recommend iron if TSAT ≤ ____ and ferritin is ≤ ____ KDOQI guidelines recommend iron if TSAT ≤ ____ and ferritin is ≤ ____ (non-HD) and ____ (HD)
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
ESAs help maintain ___ levels & reduce the need for _____, but they are ineffective if iron stores are low
Hgb Blood transfusions
51
Epoetin alfa brand name
Epogen, Procrit
52
Darbepoetin brand name
Aranesp
53
How many times per week is Epoetin alfa given in CKD
3x/week
54
Epoetin alfa is initiated when Hgb < __ g/dL in CKD and cancer patients
10
55
Epoetin alfa dose should be decreased or interrupted when Hgb approaches or exceeds __ g/dL (CKD or HD)
11
56
Darbepoetin for CKD is given IV or SC how many times per week (for HD)
once weekly (or q2weeks) | non-HD is every 4 weeks
57
ESA boxed warnings
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
ESAs can cause what side effects
Hypertension, arthralgia
59
ESA monitoring
Hgb, Hct, TSAT, serum ferritin, BP
60
ESA's recommended route for HD patients
IV
61
How should ESAs be stored
in the refrigerator; do not shake
62
The darbepoietin half-life is __-fold longer than epoetin alfa
3-fold (can be given once weekly for this reason)
63
Causes of hemolytic anemia
Drug-induced or G6PD deficiency
64
Which test is used to detect antibodies that are stuck to the surface of RBCs in hemolytic anemia
Direct Coombs test
65
what is the basic role of G6PD
protect RBCs from harmful substances - that's why deficiency is dangerous with certain drugs
66
Most people with G6PD deficiency should be instructed to avoid which high-risk medications
- 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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