E3 anemia Flashcards
5 signs and symptoms of anemia
- exertional dyspnea
- angina
- tachycardia
- fatigue
- pallor
normal Hgb
male
female
13.5-18
12-16
what is Hgb indicative of?
oxygen carrying capacity
MCV normal range
80-100
what is MCV indicative of?
average volume of RBCs
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%
C because below 13.5
T or F:
Iron supplementation is the first line treatment of anemia
false, depends on the type
3 common causes of anemia
- decreased RBC production
- increased RBC destruction
- Increased RBC loss
what are two things that can cause decreased RBC production?
chronic diseases
nutritional deficiencies
what are 2 things that can cause increased RBC destruction
drugs
sickle cell
what are two things than can cause increased RBC loss
- acute blood loss
- chronic NSAIDs/ASA
what is the “classic example” she mentioned that puts people at risk for anemia
CKD
microcytic size
MCV <80
Normocytic size
MCV 80-100
Macrocytic size
MCV >100
Iron deficiency:
A. Microcytic
B. Normocytic
C. Macrocytic
A
sickle cell
A. Microcytic
B. Normocytic
C. Macrocytic
A
anemia of chronic disease
A. Microcytic
B. Normocytic
C. Macrocytic
B
blood loss
A. Microcytic
B. Normocytic
C. Macrocytic
B
folic acid and/or B12 deficiency
A. Microcytic
B. Normocytic
C. Macrocytic
C
main goal of therapy that isn’t super incredible common sense
increase Hgb
2 most helpful labs for determining iron deficiency anemia
ferritin (low) and TSAT (low)
Ferritin normal value
15-200 ng/mL
what is ferritin indicative of?
iron stores
when is ferritin elevated? (2)
acute inflammation or chronic disease
TSAT normal value
20-50%
what is TSAT indicative of?
amount of iron ready for erythropoiesis
4 main causes of iron deficiency
blood loss
decreased absorption
vegetarian diet
pregnancy
T or F:
drugs are likely to be a root cause of iron deficiency
False
what is koilonychias
spoon shaped nails
sign+sx for iron deficiency
what is glossitis?
inflamed tongue
only in iron deficiency
what is pica?
craving things with no nutritional value
only for iron
what are 4 exceptions to use IV iron over oral?
- cannot tolerate side effects
- cannot absorb
- ESRD
- Heart Failure
general amount of elemental iron and how often
65mg every other day
how long does it take to replete iron stores?
3-6 months*
what is hepcidin?
iron-regulating peptide hormone
where is hepcidin produced?
liver
Hepcidin (increases/decreases) dietary iron absorption and iron transfer to the plasma
decreases
T or F:
Hepcidin is lower during inflammation
false, elevated
33% elemental iron
A. Ferrous fumarate
B. Ferrous sulfate
C. Ferrous gluconate
A
20% elemental iron
A. Ferrous fumarate
B. Ferrous sulfate
C. Ferrous gluconate
B
10% elemental iron
A. Ferrous fumarate
B. Ferrous sulfate
C. Ferrous gluconate
C
T or F:
iron has decreased absorption on empty stomach
false, increased
3 counseling points to let pts know about oral iron
- upset stomach
- constipation
- dark stools
what can increase absorption of oral iron?
vitamin C (ascorbic acid)
4 indications of IV iron
- ESRD
- heart failure
- failed oral
- malabsorption
2 side effects of IV iron
- hypotension during infusion
- skin tattooing (rare)
value indicative of b12 deficiency
<200
cobalmin
b12
what two meds can cause b12 deficiency
PPis and metformin
2 diet-related things that can cause b12 deficiency
vegan/vegetarian
alcoholism
T or F:
the body can produce vitamin b12
false, must be from diet
main consequence of b12 deficiency
neurologic shit like weakness, numbness, cognitive dysfunction
general daily amount for b12 replacement
1000 mcg
when may b12 replacement therapy not be as effective?
in pernicious anemia *
T or F:
b12 is water soluble
true, means you can give extra and it’ll just get pissed out
treatment for folic acid deficiency
oral folic acid
1-5 mg daily until Hgb normalizes
T or F:
Folic acid is water soluble
True
never replace folic acid without checking ?
b12 *
4 common disease states for anemia of chronic disease
CKD
CHF
Cancer
HIV/AIDS
what stimulates production of RBCs?
erythropoietin
where is eyrthropoietin produced?
kindeys
what do you avoid in anemia of CKD?
blood transfusions*
in what kind of pts do you use IV iron? (not the normal exceptions)
hemodialysis
what is the target TSAT in anemia of CKD?
above 30%
what can be given to help prevent blood transfusions?
ESA’s
T or F:
you should target normal Hgb levels in anemia of CKD
false, says DO NOT
what do you do first before starting an ESA?
replenish iron stores
which has shown benefit in heart failure, oral or IV iron?
IV
T or F:
ESAs should be initiated in HF pts after iron stores are replenished
false, do not give ESAs in HF
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
C
first step in blood loss anemia
stop the bleeding duh
you should transfuse packed RBCs in blood loss anemia when Hgb < _?
7
each unit of packaged RBCs contains ___mg iron
250
2 types of hemolytic anemia
inherited and acquired (drug induced)
if you see the word spleen at all at any point what should you think of?
sickle cell anemia
4 treatment options for sickle cell
- folic acid
- blood transfusions
- hydroxyurea
- immunizations
