Iron Deficiency Anemia

Question 1

Anemia

Answer 1

-decrease in hgb, resulting in decrease O2 carrying capacity of blood

Question 2

Clinical Presentation of Acute Onset Anemia

Answer 2

• tachycardia
• lightheadedness
• breathlessness

Question 3

Clinical Presentation of Chronic Onset Anemia

Answer 3

• fatigue, weakness, faintness
• HA
• vertigo
• loss of skin tone
• pallor
• sensitivity to cold

Question 4

Lab Evaluation for Anemia

Answer 4

• CBC with RBC indices
• reticulocyte count
• stool sample for occult blood

Question 5

Normal Serum Iron Levels

Answer 5

M 55-160

F 40-155

Question 6

Normal Ferritin

Answer 6

M 20-500

F 20-200

Question 7

Normal TIBC

Answer 7

250-400

Question 8

Normal Retic Count

Answer 8

0.5-1.5%

Question 9

Normal Folic Acid Levels

Answer 9

> 3.5

Question 10

Normal B12 Levels

Answer 10

200-700

Question 11

What are some common causes of IDA?

Answer 11

• inadequate dietary intake (EtOH, poor nutrition, anorexia)
• inadequate absorption from GI tract
• increased iron demands (infancy, pregnancy)
• blood loss
• certain dzs (RA, malignancies, renal dz)

Question 12

Signs and Sxs of IDA

Answer 12

• koilonychia (spooning of fingernails)
• angular stomatitis
• glossitis
• pica

Question 13

Lab Findings in IDA

Answer 13

• low serum iron
• low ferritin
• high TIBC
• hgb, hct, RBC normal early, but decrease late

Question 14

Treatment of IDA

Answer 14

• find and tx underlying cause
• give iron to correct anemia and replace stores
• dietary supplementation
• oral or parenteral iron preparations
• blood transfusions

Question 15

Dietary Supplementation of Iron: what works and what doesn’t

Answer 15

• heme iron in meat/poultry absorbed 3x better than non-heme iron from veggies and iron supplements
• gastric acid and ascorbic acid increase absorption of non-heme iron
• milk and tea decrease iron absorption

Question 16

Where in GI system does maximum iron absorption take place?

Answer 16

• maximum in duodenum

- less in small intestine

Question 17

How should iron be taken?

Answer 17

• best absorbed when taken w/o food or other meds

- better tolerated w/ smaller, more frequent doses

Question 18

Typical Dosing Regimen for IDA

Answer 18

-ferrous sulfate 324-325 mg TID

Question 19

Why is ferrous gluconate better tolerated than ferrous sulfate?

Answer 19

-has less iron in it than ferrous sulfate (by about 1/2)

Question 20

Oral Iron AEs

Answer 20

-GI: dark feces, abd pain, heartburn, N/V/C

Question 21

What might absence of AEs with iron indicate?

Answer 21

-nonadherence

Question 22

What can pts do if oral iron is not tolerated?

Answer 22

• take with meals

- decrease total daily dose

Question 23

Monitoring for IDA Treatment

Answer 23

• reticulocytosis 7-10 days after therapy starts
• hgb increase of <2g/dL over 3 weeks is unacceptable and should be evaluated further
• rate of hgb increase slows as hgb normalizes

Question 24

How long is iron therapy needed?

Answer 24

-at least 2-3 months to restore then 3-6 months more to avoid relapse

Question 25

What are causes of treatment failure for IAD?

Answer 25

• nonadherence
• misdiagnosis
• malabsorption
• blood loss
• concomitant anemia-inducing state

Question 26

When should parenteral iron therapy be considered?

Answer 26

• evidence of malabsorption
• intolerance of oral iron
• long-term adherence is a problem
• chronic hemodialysis or CAPD

Question 27

What is the Z-track method and why is it used?

Answer 27

• skin/tissue pulled while needle inserted in muscle

- minimize staining of skin and prevents iron from leaving the muscle area

Question 28

AEs Specific to IM Iron Dextran Administration

Answer 28

• may cause pain at injection site
• skin staining
• tissue necrosis
• atrophy

Question 29

Iron Dextran AEs

Answer 29

• arthalgias, myalgias
• flushing, allergic reactions
• malaise
• fever
• rarely anaphylaxis