From Review: Anemia Flashcards
what is hemosiderosis
iron overload w/high oral iron intake (or even regular diet), accumulate in body. asymptomatic until burden exceeds 5 g
who has hemosiderosis
in ppl w/hemochromatosis, acerulopasminemia, hypotransferrinemia/atransferrinemia
what occurs in hemochromatosis
more iron is absorbed than normal, and serum ferritin > 300 mg/dL
what is hemochromatosis
1% of ppl. hereditary disorder where iron stores reach 20-40 g (N: 1-3 g)
- s/s hemochromatosis
cirrhosis, liver cancer, diabetes, bronze skin, cardiomyopathy, arrhythmias, heart failure, ad pain, arthritis
hemosiderosis & hemochromatosis Tx
phlebotomy. removing 500mL of blood removes 250 mg of Fe.
iron toxicity associated w/
multiple blood transfusions in pts w/hereditary anemias, then Deferoxamine is used to remove excess iron as phlebotomy would make anemia worse
IM & IV Fe sups
Iron dextan - Imferon, Infed, DexFerrum
IM & IV iron sup dose
up to 100 mg/day based on wt and blood values
IM & IV Fe sup side effects
anaphylaxis, fever, lymphadenopathy, vomit, flushing, headache, dizziness, seizure, syncope, hypotension, tachycardia, taste disorder, urticariapain and staining at injection site, phlebitis, cancer
- multiple doses of … (less adverse reactions)
iron sucrose (venofer) or ferric gluconate (ferrlecit) can also be used to treat Fe deficiency
sickle cell anemia: serum ferritin may be
falsely elevated during a SCE crisis
- false high serum ferritin may occur in
infection/inflammation inflammatory bowel diseases some cancers like Hodgkin's and leukemia liver disease RA recent blood transfusion menstruation some meds
in underproduction
reticulocyte ct is low
in loss or destruction
reticulocyte ct is high
usual % reticulocytes
slides say > 5% (case study in note say 0.5-1.5% normal)
mean reticulocyte hemoglobin content (CHr)
normal > 27 pg per cell
reticulocytosis
increased RBC production
reticulocytopenia
decreased RBC production
anisocytosis
varied RBC size
poikilocytosis
varied RBC shape
microcytosis
decrease in RBC size
hypochromasia
pale RBCs
Cobalamin status assessments
- plasma or serum B12
- methylmalonic acid excretion and serum MMA
- serum total homocysteine
- deoxyuridine suppression test
- schilling test
- plasma/serum B12
low level indicates deficiency. (N > 300 pg/mL)
- serum methylmalonic acid and (MMA) excretion
elevated MMA indicates B12 deficiency, as high as 300 mg/day (N 0-3.5 mg/24 hr)
earlier indication then plasma cobalamin
- serum total homocysteine
elevated in cobalamin def, also in folate and pyridoxine defs.
Deoxyuridine (dU) –>
thymidine (w/adequate B12/folate)
- deoxyuridine suppression test
cobalamin/folate def cause suppression (less incorporation).
test is ran w/both vits add to test separately to determine which vit is lacking.
- schilling test
test of cobalamin absorption. low urine excretion of radioactive cobalamin = cobalamin malabsorption
folic acid status assessment
- serum/plasma folate
- erythrocyte folate
- FIGLU excretion
- dU suppression test
- serum homocysteine
- serum/plasma folate
def < 3ng/mL (3-6 marginal status)
- erythrocyte folate
less sensitive to short term fluctuation than plasma, better reflects tissue stores
- Formiminoglutamate (FIGLU) excretion
elevated in folate & B12 def, also liver disease, cancer, TB
FIGLU excretion may be low even when folate def is present in
kwashiorkor, pregnancy, anticonvulsants
histidine w/adequate folate
–> glutamic acid
histidine w/out adequate folate
–> FIGLU
- deoxyuridine (dU) suppression test
assess ability of nonradioactive dU to suppress labeled thymidine incorporation into . folate or B12 def cause suppression (less incorporation).
- serum total homocysteine
elevated in folate, B12, B6 defs
anemia of chronic disease like
RA, lupus, cancer, chronic infections, inflammatory bowel diseases. may be normocytic/microcytic.
anemia of chronic disease characteristics
poor response to erythropoietin, high cytokine mediated, short RBC half-life, high hepcidin causes poor iron mobilization/efflux from storage, inflammation.
no nutr Tx
normocytic: aplastic anemia
bone marrow failure, pancytopenia, congenital like Fanconi’s anemia, viral/drug/chemical exposure, no nutr tx, only cure is bone marrow transplant (BMT)
normocytic: myelopathic disorders/ myelodysplasis
usually have pancytopenia. ex. preleukemia or stem cell disorders. give transfusions, no nutr tx, cure MBT
normocytic: myelodysplastic syndrome pts may get
acquired sideroblastic/refractory anemia w/ringed sideroblasts (RARS)
RARS may be d/t
INH, cycloserine, chloroamphenicol & alcohol, lead or zinc toxicity
RARS try giving
100-200 mg pyroxene per day
normocytic: PEM
provide pt/ NS to correct PEM
normocytic: CKD
give EPO and hematopoietic nutrients as needed
normocytic: hepatic disorders
anemia is often mildly macrocytic, no nutr tx
normocytic: endocrine disorders
treat underlying condition, not nutr tx
normocytic: chemotherapy/med related anemia
chemo and AIDS treatments like AZT often cause anemia. usually respond to Procrit (epoetin alfa) erythropoietin injections
folate deficiency can be induced by
methrotrexate (amethopterin, folex, rheumatrex) cancer chemo agent and treat RA and psoriasis
methotrexate taken as chemo agent
high folate intake may decrease med’s effectiveness
methotrexate taken for other disorders
folate sups may be used prophylactically and do not decrease med’s effectiveness
Phenytoin (Dilantin) therapy
folate status decline and def (macrocytic anemia) has been reported
folate sup may
decrease Dilantin’s anticonvulsant effect so min amt of folate should be used to control def symtoms
dilantin: 800 mcg folate
may increase seizure frequency in some cases
“typical dose 250-1000 mcg/day”
meds and folic acid
antacids anticonvulsants aspirin cycloserine diuretics famotidine
meds that impact B12 status/absorption
nitrous oxide, cholestyramine, INH, neomycin, metformin, H2 receptor blockers, PPIs (Nexium, Prevacid, Prilosec), psychiatric (phenobarbital, dilantin)
hydroxyurea med
decreases painful episodes of sickle cell anemia
hemolytic anemias avoid
fava beans, some dyes, and some meds: antimalarials and aspirin (cause oxidative stress and hemolytic attack)
meds that decrease iron absorption
cholestryramine, clofibrate, neomycin, PAS
