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PHRM 864 > E3 anemia > Flashcards

E3 anemia Flashcards

1
Q

5 signs and symptoms of anemia

A
  • exertional dyspnea
  • angina
  • tachycardia
  • fatigue
  • pallor
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2
Q

normal Hgb
male
female

A

13.5-18
12-16

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3
Q

what is Hgb indicative of?

A

oxygen carrying capacity

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4
Q

MCV normal range

A

80-100

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5
Q

what is MCV indicative of?

A

average volume of RBCs

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6
Q

Which of the following patients have anemia (select all that apply)?

A. 45 year old female with Hgb 12.5g/dL
B. 28 year old female vegetarian female with fatigue and MCV 72 mm3
C. 74 year old male with Hgb 12.5g/dL
D. 33 year old male with Hct 36% and RDW of 11.5%

A

C because below 13.5

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7
Q

T or F:
Iron supplementation is the first line treatment of anemia

A

false, depends on the type

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8
Q

3 common causes of anemia

A
  • decreased RBC production
  • increased RBC destruction
  • Increased RBC loss
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9
Q

what are two things that can cause decreased RBC production?

A

chronic diseases
nutritional deficiencies

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10
Q

what are 2 things that can cause increased RBC destruction

A

drugs
sickle cell

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11
Q

what are two things than can cause increased RBC loss

A
  • acute blood loss
  • chronic NSAIDs/ASA
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12
Q

what is the “classic example” she mentioned that puts people at risk for anemia

A

CKD

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13
Q

microcytic size

A

MCV <80

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14
Q

Normocytic size

A

MCV 80-100

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15
Q

Macrocytic size

A

MCV >100

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16
Q

Iron deficiency:
A. Microcytic
B. Normocytic
C. Macrocytic

A

A

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17
Q

sickle cell
A. Microcytic
B. Normocytic
C. Macrocytic

A

A

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18
Q

anemia of chronic disease
A. Microcytic
B. Normocytic
C. Macrocytic

A

B

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19
Q

blood loss
A. Microcytic
B. Normocytic
C. Macrocytic

A

B

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20
Q

folic acid and/or B12 deficiency
A. Microcytic
B. Normocytic
C. Macrocytic

A

C

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21
Q

main goal of therapy that isn’t super incredible common sense

A

increase Hgb

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22
Q

2 most helpful labs for determining iron deficiency anemia

A

ferritin (low) and TSAT (low)

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23
Q

Ferritin normal value

A

15-200 ng/mL

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24
Q

what is ferritin indicative of?

A

iron stores

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25
Q

when is ferritin elevated? (2)

A

acute inflammation or chronic disease

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26
Q

TSAT normal value

A

20-50%

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27
Q

what is TSAT indicative of?

A

amount of iron ready for erythropoiesis

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28
Q

4 main causes of iron deficiency

A

blood loss
decreased absorption
vegetarian diet
pregnancy

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29
Q

T or F:
drugs are likely to be a root cause of iron deficiency

A

False

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30
Q

what is koilonychias

A

spoon shaped nails
sign+sx for iron deficiency

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31
Q

what is glossitis?

A

inflamed tongue
only in iron deficiency

32
Q

what is pica?

A

craving things with no nutritional value
only for iron

33
Q

what are 4 exceptions to use IV iron over oral?

A
  • cannot tolerate side effects
  • cannot absorb
  • ESRD
  • Heart Failure
34
Q

general amount of elemental iron and how often

A

65mg every other day

35
Q

how long does it take to replete iron stores?

A

3-6 months*

36
Q

what is hepcidin?

A

iron-regulating peptide hormone

37
Q

where is hepcidin produced?

A

liver

38
Q

Hepcidin (increases/decreases) dietary iron absorption and iron transfer to the plasma

A

decreases

39
Q

T or F:
Hepcidin is lower during inflammation

A

false, elevated

40
Q

33% elemental iron
A. Ferrous fumarate
B. Ferrous sulfate
C. Ferrous gluconate

A

A

41
Q

20% elemental iron
A. Ferrous fumarate
B. Ferrous sulfate
C. Ferrous gluconate

A

B

42
Q

10% elemental iron
A. Ferrous fumarate
B. Ferrous sulfate
C. Ferrous gluconate

A

C

43
Q

T or F:
iron has decreased absorption on empty stomach

A

false, increased

44
Q

3 counseling points to let pts know about oral iron

A
  • upset stomach
  • constipation
  • dark stools
45
Q

what can increase absorption of oral iron?

A

vitamin C (ascorbic acid)

46
Q

4 indications of IV iron

A
  • ESRD
  • heart failure
  • failed oral
  • malabsorption
47
Q

2 side effects of IV iron

A
  • hypotension during infusion
  • skin tattooing (rare)
48
Q

value indicative of b12 deficiency

A

<200

49
Q

cobalmin

A

b12

50
Q

what two meds can cause b12 deficiency

A

PPis and metformin

51
Q

2 diet-related things that can cause b12 deficiency

A

vegan/vegetarian
alcoholism

52
Q

T or F:
the body can produce vitamin b12

A

false, must be from diet

53
Q

main consequence of b12 deficiency

A

neurologic shit like weakness, numbness, cognitive dysfunction

54
Q

general daily amount for b12 replacement

A

1000 mcg

55
Q

when may b12 replacement therapy not be as effective?

A

in pernicious anemia *

56
Q

T or F:
b12 is water soluble

A

true, means you can give extra and it’ll just get pissed out

57
Q

treatment for folic acid deficiency

A

oral folic acid
1-5 mg daily until Hgb normalizes

58
Q

T or F:
Folic acid is water soluble

A

True

59
Q

never replace folic acid without checking ?

A

b12 *

60
Q

4 common disease states for anemia of chronic disease

A

CKD
CHF
Cancer
HIV/AIDS

61
Q

what stimulates production of RBCs?

A

erythropoietin

62
Q

where is eyrthropoietin produced?

A

kindeys

63
Q

what do you avoid in anemia of CKD?

A

blood transfusions*

64
Q

in what kind of pts do you use IV iron? (not the normal exceptions)

A

hemodialysis

65
Q

what is the target TSAT in anemia of CKD?

A

above 30%

66
Q

what can be given to help prevent blood transfusions?

A

ESA’s

67
Q

T or F:
you should target normal Hgb levels in anemia of CKD

A

false, says DO NOT

68
Q

what do you do first before starting an ESA?

A

replenish iron stores

69
Q

which has shown benefit in heart failure, oral or IV iron?

A

IV

70
Q

T or F:
ESAs should be initiated in HF pts after iron stores are replenished

A

false, do not give ESAs in HF

71
Q

Patient is a 59 year old female with heart failure. Her ejection fraction is 30%. Her physician asks you if she would benefit from iron. Which response is most appropriate?

A. Patients with heart failure benefit from oral iron supplementation
B. All patients with heart failure benefit from IV iron
C. IV iron decreases hospitalization in certain patient with heart failure, but there is no evidence that it will improve survival
D. IV iron improves survival in patients with heart failure

A

C

72
Q

first step in blood loss anemia

A

stop the bleeding duh

73
Q

you should transfuse packed RBCs in blood loss anemia when Hgb < _?

A

7

74
Q

each unit of packaged RBCs contains ___mg iron

A

250

75
Q

2 types of hemolytic anemia

A

inherited and acquired (drug induced)

76
Q

if you see the word spleen at all at any point what should you think of?

A

sickle cell anemia

77
Q

4 treatment options for sickle cell

A
  • folic acid
  • blood transfusions
  • hydroxyurea
  • immunizations

PHRM 864 (28 decks)

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