Lecture 11 - Anemia Flashcards
WHO anemia definition
< 13g/dL = men
< 12 g/dL = women
Microcytosis (<80) MCV usually….
iron deficiency
Normocytosis (80-100) MCV usually….
acute blood loss anemia, mixed anemia (Iron/B12)
Macrocytosis (>100) MCV usually….
Vit B12 deficiency, folate deficiency
Low MCH usually….
Microcytosis or hypochromia
High MCH usually…..
Macrocytosis (Vit B12, folate deficiency)
Low MCHC usually….
Hypochromia (iron deficiency )
Normal RDW usually means….
Anemia of inflammation, acute blood loss anemia
Higher RDW usually means….
early IDA, mixed anemia (IDA & B12/Folic acid), hemolysis
Low Reticulocyte count usually means….
IDA, B12 deficiency
Anemia of inflammation, Anemia of renal disease
Higher Reticulocyte count usually means….
acute blood loss or hemolysis
Anemia Diagnosis Process
- CBC
- RBC indices
- Additional diagnostic tests
Acute Symptoms of Anemia
Angina
Tachycardia
Palpitations
Hypotension
Orthopnea
Exercise intolerance
Chronic Symptoms of Anemia
Fatigue
Vertigo
Headache
Cold sensitivity
Loss of skin tone
Indications for blood transfusions
Hgb < 7 = normal, stable pts
Hgb < 8 = CVD, or ortho/cardiac surgery
reasons for iron deficiency
inadequate ingestion
inc requirements
dec absorption
blood loss
IDA clinical presentation
Asymptomatic
Angular stomatitis = cracking edge of lips
Glossitis
Papillary atrophy of tongue
Spoon nails (Koilonychia)
Pica = craving nonfood substances?
IDA diagnosis
Dec: Hgb/Hct, MCV, MCH, Ferritin, Serum iron, Tsat
Inc = TIBC, RDW
Who should be screened for IDA?
all preg women
pre and post weight loss surgery
Non-pharm IDA
inc iron intake form food
OJ/Vit C = inc absorption
Milk/Tea = reduce absorption
How to help with GI upset from Oral iron therapy
convert to iron will lower elemental %%
Dosing oral iron
Traditional = 150-200mg elemental/day in 2-3 doses
Novel = 40-80 elemental every other day
Duration ~3-6 months after anemia resolves to get ferritin > 100
Iron counseling points
Take on empty stomach to inc absorption (1hr before or 2hr after meal)
Keep iron away from children
GI side effects, admin with food or lower dose can help
Causes for “Failure to respond”
non-adherence to therapy
Inability to absorb iron
Continued bleeding
Incorrect diagnosis
Concurent inflammatory conditions impairing response
Indications for IV iron therapy
Intolerance to oral iron
Nonadherence to oral iron
in conjunction w/ ESA therapy
Malabsorption
Need for rapid replacement
General IV iron dosing
wt (lbs) X Hgb deficit = dose MG
add ~600mg women, ~1000mg men
Iron Dextran info
Have to give test dose due to anaphylaxis
IV push or IV infusion (not approved)
Feraheme info
can alter MRI images for up to 3 months
How often monitoring iron?
~ 4 weeks
caution overload Ferritin > 800, TSAT > 50%
Reasons for B12 deficiency
inadequate dietary intake of B12
Impaired absorption of B12
Inadequate utilization of B12
B12 Deficiency Presentation
Hyperpigmentation, jaundice, vitiligo
Neurologic symptoms are the big thing, can be permanent
B12 Deficiency Labs
Dec: Hgb/Hct, B 12 < 150, Reticulocyte count, milk leukopenia/thrombocytopenia
Inc: MCV, MMA, Homocysteine
How to decide if you get IM or Oral B12?
Based if you have neurologic symptoms
if you do, you need it quickly so you get B12 IM
Folate deficiency presentation
Depression
Reduced taste
Diarrhea, red/sore tongue
General ssx of anemia
Folate deficiency lab values
Dec: Hgb/Hct, Retic count
Serum folate < 3, RBC folate < 150
Inc: MCV > 100, Homocysteine
