Final Quiz: Anemia Flashcards
Anemic Hgb Men
Under 13
Anemic Hgb Women
Under 12
Severely anemic Hgb Men/Women
7
Treatment for severe acute anemia
Give blood
Acute presentation of anemia
Heart-related problems
Fatigue-related problems
Macrocytic
Normocytic
Microcytic
> 100
80-100
<100
Low TSAT in acute anemia
Less than 20%
TIBC if iron-related
Over 400
TIBC if not iron-related
Less than 250
Normal Ferratin and change seen in iron-deficient anemia
100-200 : will be decreased
Normal Retics
1%
Normal MMA and change seen in B-12 deficiency
0.07-0.27 : will be elevated
Normal Homocysteine and change seen in B-12 AND Folate deficiency
Less than 15 : will be elevated
Site of iron absorption
Duodenum
Reasons for decreased Iron-absorption
Duodenum removed Enteritis Chelation - Di-valent cations - Tetras/FQ/PCN - Cholestyramine Increased pH - Achlorhydria - Acid reducing agents Levodopa/Methyldopa Levothyroxine Mycophenolate
Reasons for increased Iron-requirements
Bleeding (including menstruation) Rapid growth - Infants - Pregnancy - Lactation
Progression of Iron-imbalance
Stores reduced : decreased Ferratin
Stores depleted : decraesed TSAT, increased TBIC
Anemic : Hgb less than normal
Signs of Iron-deficiency
Glossitis (tongue) Angular Cheilitis (mouth) Koilnychia (nails) Blue sclera Pica
Oral Iron products and strengths
Ferrous Sulfate : 65mg elem. 20%
Ferrous Gluconate : 35mg elem. 11%
Ferrous Fumarate : 99mg elem. 33%
SE’s from Oral Iron products
Constipation Nausea Diarrhea Abdominal cramping Dark stools*
Why are practitioners beginning to recommend q48hr dosing for Oral Iron products?
Hepcidin release in response to iron doses
- Decreases absorption for 48 hours
Source of Iron
Anything with blood in it
Veggies
Nuts
Etc.
Source of Folate
Green leafy veggies
Source of B12
Animal products basically
Main differences in symptoms between Folate and B12 deficiencies
Neurological symptoms with B12 deficiency only.
What two drugs require Folate supplementation?
Methotrexate
Sulfasalazine
Folate replacement therapy
1 mg PO daily ONLY if you have ruled out B12 deficiency
What is IFa test used for?
To rule in or out Pernicious Anemia
B12 replacement therapy if no neuro symptoms
1 mg PO daily
B12 replacement therapy if + neuro symptoms
1 mg IM q48hr for 2 weeks
Then
1 mg IM monthly
Most common cause of chronic anemia
CKD leading to decreased EPO production
When is Iron-replacement therapy indicated in CKD patients?
When TSAT /< 30% regardless of +/- ESA
Typical oral/IV iron dose in CDK patients
About 1,000mg elemental iron in both
When to use caution with IV iron?
If patient has active infection.
Iron Dextran
25mg test dose
100mg x 10
When to hold iron therapy?
If TSAT > 50%
INFeD
+/- 25mg test dose
1g over 8hrs
IV Ferric Gluconate
125mg x 8
IV Iron Sucrose
100-500 over 30min-4hr x 10
When are blood tranfusions warranted?
If Hgb < 7
or
It’s really low and they are symptomatic
When to consider ESA therapy
If Hgb < 10 AFTER or along with Iron replacement
ESA therapeutic goal
Hgb 10-11
Darbapoetin initial dose
- 45 mcg/kg monthly
- IV if on dialysis
- SQ if not on dialysis
Epoetin alfa initial dose
50-100 units/kg/dose…
- 3 times weekly IV if on dialysis
- Weekly SQ if not on dialysis
ESA-agent SE’s
Hypertension*
Thrombosis
ESA agent conversion rules
If Epoetin 3xweekly -> Darba weekly
If Epoetin 1xweekly -> Darba bi-weekly
- Multiply Epoetin dose by 2 before converting
ESA Resistance: Definition and Risk Factors
Definition: requiring more than 150 u/kg ESA 3xweekly.
Risk Factors:
- Iron deficient
- Aluminum tox. (decreases EPO prod.)
