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Oncology > Nonmalignant Anemia > Flashcards

Nonmalignant Anemia Flashcards

1
Q

Anemia

A
  • Decrease in proportion of red blood cells
  • Reduced oxygen carrying capacity of blood
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2
Q

What is the level of Hgb for symptomatic anemia?

A

Hgb < 7 g/dL

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3
Q

What is the general causes of anemia?

A
  • Decreased RBC production
  • Increased RBC destruction
  • Blood loss
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4
Q

What is the mechanism of anemia?

A
  • Increased destruction – blood loss acute or chronic in surgery, trauma, hemorrhage, menses
  • Hemolytic anemia – autoimmune, infectious, hereditary like sickle cell, G6PD
  • Deficient or defective erythropoiesis
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5
Q

What are some signs of anemia?

A
  • Weakness
  • Tiredness
  • Lethargy
  • Restless legs
  • SOB esp exertional
  • Chest pain, reduced exercise tolerance with severe dis
  • PICA
  • Mild anemia without sx
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6
Q

What are the symptoms of anemia?

A
  • Skin cool to touch
  • Tachypnea & Hypotension (severe)
  • Pale conjunctiva
  • Jaundice (hemolysis)
  • Glossitis, cheilitis (iron, folate, B12)
  • Splenomegaly (hemolysis)
  • Hepatomegaly (alcohol)
  • Tachycardia, murmur
  • Decreased perception of vibration B12
  • Rectal bleeding
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7
Q

Lab levels of Hemoglobin

A
  • Male: 13.5-17.5
  • female: 12.0-16.0 g/dL
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8
Q

Lab levels of Hematocrit (Hct)

A

Actual volume of RBCs in unit volume of whole blood
* Male: 41-53%
* female: 36%

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9
Q

Lab levels of Absolute Reticulocyte Count

A

indirect assessment of new RBC production: 0.5-1.5%
* Value > 2% suggests hemolysis or acute blood loss

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10
Q

Lab levels of Mean Corpuscular Volume (MCV)

A

Average volume of RBCs: 80-100

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11
Q

1.

Lab level of Mean Corpuscular Hemoglobin

A

% volume of hemoglobin in RBC: 26-34
* Reflects the adequacy of iron supply to developing erythron

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12
Q

What is the absorption of ferrous (Fe2+) form?

A
  • Standard western diet ~ 12-15 mg of iron mainly in the ferric (Fe3+) non-absorbed form
  • Ferric iron (Fe3+) ionized by stomach acid, reduced to ferrous (Fe2+) form
  • Primarily absorbed in the duodenum via intestinal mucosal cell uptake
  • Subsequently transferred across the cell into the plasma
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13
Q

Who are the highest risk group for Iron Deficiency Anemia?

A
  • Children < 2 years
  • Adolescent girls
  • Pregnant females
  • Elderly > 65 years
  • Malabsorptive syndromes
  • Diet
  • Blood loss
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14
Q

What is the iron dietary allowance for menstruating females?

A

18 mg

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15
Q

What is the iron dietary allowance for pregnant females?

A

27 mg

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16
Q

Reference range of serum iron

A
  • Male: 50-160
  • Female: 40-150
17
Q

Reference range of serum ferritin

A
  • Male: 15-200
  • Female: 12-150
18
Q

What is the oral treatment of Iron Deficiency Anemia?

A

65 mg of elemental iron once every other day or on Monday, Wednesday, and Friday
* Older adult: Lower doses (15 to 50 mg elemental iron/day)

19
Q

What are some notable counseling for oral elemental iron?

A
  • GI effects metallic taste, N/V (#2), constipation (#1), diarrhea (#3)
    -Tolerance improves with small initial dose, gradual escalation to full dose, new dosing strategy
  • Administration at least 1 hour before meals
    -May take with food if the patient experiences nausea
20
Q

What are drugs that decrease iron absorption?

A
  • Al-, Mg-, Ca2+ anatacids
  • Tetracycline and doxycycline
  • Histamine2 antagonists
  • Proton pump inhibitor
  • Cholestyramine
21
Q

When are IV iron products preferred?

A
  • Poor GI absorption
  • Lack of response to or poor tolerability or oral iron
  • Chronic kidney disease
  • Active inflammatory bowel disease
  • Chronic or extensive blood loss
  • Gastric bypass
21
Q

What are some drugs that are affected by iron?

A
  • Levodopa DECREASE (chelates with iron)
  • Methyldopa DECREASE (decreases efficacy of methyldopa)
  • Levothyroxine DECREASE (decreased efficacy of levothyroxine)
  • Penicillamine DECREASES (chelates with iron)
  • Fluoroquinolones DECREASES (forms ferric ion-quinolone complex)
  • Tetracycline/doxycycline DECREASE (when within 2 hours of iron salt)
  • Mycophenolate DECREASES (decreased absorption)
22
Q

What is the equation for the total replacement dose (mg of iron)?

A

0.6 x wt (kg) x [100 – (actual hemoglobin/12 x 100)]

23
Q

What are some monitoring parameters of Iron Deficiency Anemia?

A

Reticulocytosis in 7-10 days, Resolution of anemia by 6-8 weeks

24
Q

Megaloblastic Anemia

A
  • Macrocytosis caused by abnormal DNA metabolism resulting from vitamin B12 or folate deficiency
  • Results from interference with folic acid and vitamin B12 interdependent nucleic acid synthesis in the immature erythrocyte
    • Rate of RNA & cytoplasm production exceeds the rate of DNA production
    • Results in immature, large RBCs or macrocytosis
25
Q

What is the absorption of vitamin B12?

A
  • Dietary cobalamin enters the stomach
    • Pepsin and hydrochloric acid release cobalamin from animal proteins
    • Cobalamin binds to R-protein to form cobalamin-R-protein complexes
    • Pancreatic enzymes degrade biliary and dietary cobalamin-R-protein complexes releasing free cobalamin
    • Cobalamin then binds with intrinsic factor
26
Q

What are some risk factors for Vitamin B12 deficiency anemia?

A
  • Inadequate absorption
  • Perniccious anemia - absence of intrinsic factor
  • Cobalamin malabsorption
27
Q

What can lead to pernicious anemia?

A
  • Autoimmune destruction of gastric parietal cells
  • Atrophy of gastric mucosa
  • Stomach surgery included gastric bypass
  • Europeans of northern descent
  • African Americans
  • Rare under age 35
28
Q

What leads to cobalamin malasorption?

A
  • Inability of vitamin B12 to be cleaved and released from proteins in food
  • Due to inadequate gastric acid production
  • Subtotal gastritis leading to decreased acid pepsin production
  • Prolonged use of acid suppression therapy (PPI, H2RA), metformin
29
Q

What are some neurologic findings of Vitamin B12 Deficiency Anemia?

A
  • Numbness
  • Paresthesias
  • Peripheral neuropathy
  • Ataxia
  • Diminished vibratory sense
  • Decreased proprioception
  • Imbalance
  • Vision changes
  • Psychiatric changes
30
Q

What are some symptoms of Vitamin B12 Deficiency Anemia?

A
  • Glossitis
  • Muscle weakness
  • Decreased exercise tolerance
  • Fatigue
  • Dizziness
  • Irritability
  • Weakness
  • Palpitations
  • Vertigo
31
Q

What is the treatment regimen for Vitamin B12 Deficiency?

A

IM vitamin B12:
* 1,000 mcg daily for 1 week
* Then, 1,000 mcg weekly for 1 month
* Then, monthly thereafter

Oral vitamin B12:
* 1-2 mg daily

32
Q

What is the normal folic acid content of the body?

A

5-10 mg

33
Q

Neural tube defects prevention

A
  • All women should take 0.4 mg folic acid daily beginning 1 month pre-conception
  • Increase to 4 mg/day if previous NTD pregnancy
34
Q

What are some risk factors of folic acid deficiency?

A
  • Eating habits
  • Malabsorption syndromes
  • Hyperutilization - Pregnancy and hemolytic anemia
35
Q

What are some folic acid deficiency lab test?

A
  • Mean Corpuscular Volume (MCV) > 100 – Macrocytic
  • Folic acid
  • Decreased serum folic acid levels indicate folic acid deficiency anemia
  • Erythrocyte folic acid level less volatile than serum levels
  • Reference range (ng/mL): 3-20
36
Q

What is the treatment regimen forr folic acid deficiency?

A
  • 1 mg daily in most cases
  • 1-5 mg daily in cases of malabsorption
  • 500 mcg with anticonvulsants drugs

Oncology (14 decks)

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