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Therapeutics > exam 3 lecture 8 > Flashcards

exam 3 lecture 8 Flashcards

1
Q

what is anemia

A

low RBC count or decrease of hemoglobin

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2
Q

How do you know if patient has anemia

A

Hemoglobin in blood

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3
Q

signs and symptoms of anemia

A

exertional dyspnea (SOB)
Angina
Tachycardia
Fatigue
Pallor (being pale)
may be asymptomatic

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4
Q

Normal hemoglobin for men and women

A

13.5-18 for men
12-16 for women

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5
Q

Normal MCV for rbc

A

mean corpuscular volume (size of RBC)

80-100 mm3

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6
Q

What is a normal RDW

A

RBC distribution width (11.5-14.5%)

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7
Q

What is a normal HCT value

A

38-50% male
36-46% female

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8
Q

true or false, iron is first line tx for anemia

A

False, depends on the cause of anemia

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9
Q

What are the reasons a patient might have anemia

A
  1. decreased RBC production
  2. Increased RBC destruction
  3. Increased RBC loss
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10
Q

What could be reasons for decreased RBC production

A

-Chronic disease (CKD, cancer)
-Nutritional deficiencies (iron, folic acid, B12)

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11
Q

What could cause increased RBC destruction

A
  • drugs
  • Sickle cell anemia/Thalassemia
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12
Q

What causes increased RBC loss

A
  • Acute blood loss
    -chronic NSAIDS/ASA
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13
Q

Classify RBC based on size

A
  1. Microlytic
    - MCV<80
    Iron deficiency, sickle cell, Thalassemia
  2. Normocytic
    - MCV- 80-100
    - Anemia of chronic disease, blood loss, hemolysis
  3. macrocytic
    MCV>100
    Folic Acid and or B12 deficiency
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14
Q

consequences of anemia

A

Impaired cognitive function
Falls
Heart failure
A fib
CV events
Mortality

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15
Q

What would blood work look like for iron deficiency anemia

A

Ferritin and TSAT is low

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16
Q

What is ferritin? Normal range?

A

Ferritin is a measure of iron stores.
15-200 ng/ml
( IRON DEFICIENCY IS STILL LIKELY FOR FERRITIN BELOW 45)

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17
Q

What is TSAT? normal range?

A

TSAT is the amount of iron ready for erythropoiesis

range- 20-50%

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18
Q

Drug causes for iron deficiency?

A

Drug causes unlikely for iron deficiency anemia

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18
Q

What are causes of iron deficiency

A
  1. Blood loss (menstruation, blood odnation)
  2. decreased absorption ( maximal absorption in duodenum (celiac disease and gastric bypass are at risk)
  3. Vegetarian diet
  4. Increased consumption (pregnancy)
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19
Q

additional signs and symptoms of anemia only for iron deficiency

A

Spoon-shaped nails
Inflamed tongue (glossitis)
Pica (craving substance that do not have nutritious value)

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20
Q

How to treat iron deficiency anemia

A
  1. Iron supplements
    - oral or IV iron
    (oral preferred)
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21
Q

When do we use IV instead of oral iron for low iron levels

A

Can not tolerate (side effects)
Cannot absorb
ESRD
HF

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22
Q

How much oral iron do we give patients

A

65 mg of elemental iron every other day

or

120-200 mg of elemental iron per day (divided into BID or TID)

takes 3-6 months to repletes stores

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23
Q

Why is every other day dosing for iron better?

A

Hepcidin
- Is an iron regulating hormone produced in the liver
- decreases dietary iron absorption and iron transfer to the plasma
- hepcidin is increased after a dose of oral iron for 24 hrs and normalizes within 48 hrs
Hepcidin is also elevated during inflammation

24
Q

What are the different oral iron products along with their doses and elemental iron concentrations

A

Ferrous fumarate, strength- 300 mg, elemental iron- 100 mg (33%)

Ferrous sulfate, strength- 325 mg, elemental iron- 65 mg (20%)

Ferrous gluconate, strength- 300 mg, elemental iron- 30 mg (10%)

Polysaccharide complex, strength- strength varies, 100% elemental iron

25
Q

Counseling points for iron supplements

A

-Take it on an empty stomach for absorption
- It is better tolerated with food if it causes upset stomach
- absorption increased by ascorbic acid
- Take 2 hours after PPI
- Red tarry stools
-Constipation

25
Q

Side effects of IV iron

A

Hypotension during infusion (common)
Skin tattooing (rare)

26
Q

Indications of IV iron

A

ESRD, HF, failed oral iron, malabsorption

27
Q

What are labs the point to B12 deficiency anemia

A

large MCV
large RDW
serum b12 levels low

28
Q

Causes of B12 deficicncy

A

Diet (vegeterians/vegans), alcoholism
Lack of intrinsic factor
Medications (PPI, metr=formin)

29
Q

Can our bodies make B12? Consquences of B12 deficineccy

A

our bodies can not make B12. Must absorb from diet.

Consequences
- neurologic
Weakness, Numbness, cognitive dysfunction

30
Q

How to treat B12 deficiency anemia

A

Vitamine B12 replacement (Oral or IM or SC)

31
Q

What do blood works look like for folic acid decicient anemia

A
  • MCV elevated
    B12 normal
    FOlic acid levels low
32
Q

Treatment of folic acid deficiency

A

Folic acid supplementation (oral)
(1-5 mg daily until it normalizes)

33
Q

What diseases cause anemia of chronic disease

A

One of the most common causes of anemia
- patients with chronic disease lasting months to years.

  • CKD
  • CHF
  • Cancer
    -HIV/AIDS
34
Q

Describe how anemia of CKD occurs

A

Erythropoietin is produced in the kidneys and stimulates production of RBCs

Anemia occurs bc
1. decreased erythropoietin production
2. Chronic inflammatory state which causes anemia of chronic disease
3. Nutritional deficiencies (iron, folate, vitamin B12)

35
Q

How to treat anemia of chronic kidney disease

A
  1. avoid blood transfusions
    - especially patients eligible for kidney transplantation
  2. Correct nutritional deficiencies
    - folate/b12 supplement if low
    - iron
    -use oral iron in stage 3-5 CKD if possible
    - Use IV iron in hemodialysis patients
    - target transferrin saturation (TSAT) above 30%
36
Q

What is unique in the way we treat anemia of chronic kidney disease

A

Erythropoiesis stimulating agents (ESA)
- epoietin, darbapoietin,

37
Q

What is very important to know about using ESAs in anemia of CKS?

A

DO NOT target normal hemoglobin levels.
Use minimum dose to maintain Hgb >10
Increased risk of CV events, stroke and death

38
Q

How do we treat anemia associated with HF

A

IV iron (no oral iron)

39
Q

Why do we not give iron supplements every day, only BID or every other day

A

It does not have high enough iron and it also does not wait until hepcidin levels are low

40
Q

Does IV iron improve survivability with HF

A

IV iron does not improve survivability in HF patients. it only decreases hospitalization

41
Q

How to treat blood loss anemia

A

Stop bleeding
Transfuse packed red blood cells (PRBC) when Hgb<7
- each unit of PRBC contains 250 mg iron

42
Q

When do we transfuse for blood loss

A

when hgb <7

43
Q

what is hemolytic anemia? How do you get it?

A

RBC being destroyed too quickly (before their normal 120 days)

Inherited: sickle cell anemia, G6PD deficiency
acquired: drug induced

44
Q

Define sickle cell anemia

A

RBC are irregular shape (sickles)
RBC collect in spleen and are destroyed faster than they can be produced

it is inherited

45
Q

How to treat sickle cell anemia

A

FOlic acid supplementation
Blood transfusion
Hydroxyurea

Make sure they are up to date with immunizations

Pain control (sickle cell can be painful)
- opioids in pain crisis

46
Q

What drugs could cause drug induced anemia

A

-Metformin, PPIs, (cause vitamin B12 deficiency)

  • Methotrexate, phenytoin, sulfasalazine or Bactrim (cause folic acid deficiency)
47
Q

What are labs that point towards Folic acid deficiency anemia? Name the numbers

A

High MCV (macrocytic) (over 100)
low B12 (low B12 level is less than 200)

48
Q

What would we use to treat folic acid deficiency? Include dose

A

Oral folic acid, 1000 micro grams QD
(if neurologic symtoms start IV)

49
Q

How long to see changes in hemoglobin after giving folic acid supplemet

A

3 months

50
Q

Normal hemoglobin level

A

Male- <13.5
female<12

51
Q

Normal MCV

A

80-100 normal
<80 micor
>100 Macro

52
Q

What is normal ferritin

A

<45 we consider anemia

53
Q

Normal TSAT?

A

< 20 anemia

54
Q

B12 value for anemia

A

<200 is anemia

55
Q

What value is folate for folic acid deficiency

A

<10 is anemia (folic deficiency)

56
Q
A

Therapeutics (38 decks)

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