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CMT-dos > Nutrient Deficiency Anemias > Flashcards

Nutrient Deficiency Anemias Flashcards

1
Q

Iron
Transported by and stored by (2)

A

Transported by protein Transferrin in plasma
Stored as Ferritin or as hemosiderin in macrophages (spleen, liver, bone marrow)

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2
Q

Vitamin B12 and Folate (Folic acid)

A

Both required from diet
Both necessary for DNA synthesis of RBCs (marrow) -S phase

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3
Q

iron def. anemia

classification

A

Microcytic Hypochromic Anemia

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4
Q
A
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5
Q

Iron Deficiency Anemia

Pathogenesis (stages) and etiology

A

Stage 1—progressive loss of storage iron
Stage 2—exhaustion of iron storage pool
Stage 3—frank anemia

Inadequate intake
Increased need
Impaired absorption
Chronic blood loss

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6
Q

iron anemia

Signs & Symptoms

A
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7
Q

iron anemia

labs

A

Screening tests
complete blood count (CBC)
Blood smear

Diagnostic tests
Serum iron
Total iron-binding capacity (TIBC)
Transferrin saturation
Ferritin (iron stored)
Reticulocyte count

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8
Q
high platelet count often seen with iron def. and it goes back down once corrected.
A
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9
Q

iron anemia

Tx

A
  • Treat underlying cause
  • Oral supplementation
    Ferrous sulfate oral supplements
  • Intravenous infusion
    Infed (Iron dextran) infusion
    Old standard
    Injectafer (Ferric Carboxymaltose)
    Ferrlecit (Sodium Ferric Gluconate Complex)
    Feraheme (Ferumoxytol)
    Venofer (Iron Sucrose)
  • RBC transfusion
    Severe anemia
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10
Q

advangtages and disadvantages of oral vs IV iron

A
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11
Q

ferrous sulfate

MOA, Dosing, forms

A

MOA: Replaces iron, found in hemoglobin, myoglobin, and other enzymes

Dosing: 65mg of elemental iron daily
Previously recommended up to three times daily
Studies suggest no increased absorption with this dosing (but increased side effects)

Available as tablets or solutions
Recommend patients take with OJ and/or Vitamin C (aids in absorption)
Avoid enteric coated versions (poor absorption)
Take separately from antacids
Many medications can affect absorption

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12
Q

ferrous sulfate

Adverse rxns

A

Adverse Reactions (more common)
Nausea
Darkening of stool
Constipation

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13
Q
A
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14
Q

iron anemia

follow up

A

Measure response to treatment 3-6 months into oral treatment
CBC
Iron Studies
Reticulocyte count

Patients with intravenous iron infusions
Follow up 6-8 weeks with
CBC
Reticulocyte count

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15
Q

Iron dextran (infed) (IV)

dosing, indications

A

Dosing: Calculation based; intravenous

Indications:
Lack of response to or poor tolerability of oral iron
Poor GI absorption
Chronic kidney disease
Active inflammatory bowel disease
Cancer
Chronic or extensive blood loss

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16
Q

Iron dextran (infed)

Adverse Rxns

A

Adverse Reactions
Risk of anaphylactic reaction
Need test dose prior to first administration
Delayed (1-2 days) infusion reaction
Arthralgia, back pain, chills, dizziness, fever, headache, malaise, myalgia, nausea, and/or vomiting)
Usually subside within 3-4 days
Flushing
Pruritus
Injection site skin discoloration Arthralgia

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17
Q
A
18
Q

Injectafer (Ferric Carboxymaltose)

MOA, dosing

A

MOA: A non-dextran formulation that allows for iron uptake (into reticuloendothelial system) without the release of free iron
IDA Dosing (used in pregnancy 2-3rd trimester):
≥ 50kg: 750mg IV weekly x 2 doses
< 50kg: 15mg/kg IV once

19
Q

Injectafer (Ferric Carboxymaltose)

adverse rxns

A

Adverse reactions
Hypersensitivity (not common)
Hypertension (during infusion)
Hypophosphatemia
Check level before administration
Usually resolves within 3 months
Extravasation may cause permanent skin discoloration

20
Q

Ferrlecit (Sodium Ferric Gluconate Complex)

MOA, indications, dosing

A

MOA: Supplies a source to elemental iron necessary to the function of hemoglobin, myoglobin and specific enzyme systems
Indications: IDA including hemodialysis patients (does not dialyze)
Dosing: 125mg IV infusion every 6 weeks (or with each dialysis session) for up to 8 doses

21
Q

Ferrlecit (Sodium Ferric Gluconate Complex)

adverse rxns

A

Adverse reactions
Hypersensitivity reaction (not common)
HTN
Nausea
Injection site discoloration
Muscle cramps

22
Q
A
23
Q

Sideroblastic anemia

classification
And characterized by

A

Microcytic Anemia

Disorder of Hgb synthesis
Characterized by atypical nucleated RBCs
Ringed sideroblasts are present on the bone marrow aspirate smear
Helpful to know if anemia is macrocytic, normocytic, or microcytic

24
Q

sideroblastic anemia

causes

A

Causes
Hereditary forms very rare
Manifest in childhood

Toxins: lead, copper or zinc poisoning

Drug-induced: ethanol or isoniazid

Nutritional: pyridoxine (Vitamin B6) or copper deficiency

Diseases: Rheumatoid arthritis, multiple myeloma

25
Q

Sideroblastic anemia

Tx and prognosis

A

Tx Remove offending agent
Some pts with hereditary form will respond to pyridoxine (B6)
Prognosis variable

If think it is typical iron deficiency anemia, but the history doesn’t fit, or there has been toxin or drug exposure, or the patient has RA…then it might be sideroblastic

26
Q

Sources B12 / Folate

general

A

Both play a critical role in DNA and RNA synthesis.Deficiencies may cause a cell to arrest in the DNA synthesis (S) phase of the cell cycle, make DNA replication errors, and/or undergo apoptotic death

B12
Fish, meat, poultry, eggs, milk, milk products, fortified breakfast cereals
Generally not present in plant foods
Takes years to become deficient

Folate (folic acid)
Vegetables (esp dark green leafy), fruits, nuts, beans, peas, seafood, eggs, dairy products, meat, poultry, and grains. Spinach, liver, asparagus, and brussels sprouts have high folate levels.
Weeks-months to become deficient

27
Q

B12 binds to

A

intrinsic factor

28
Q

B12 deficiency

causes

A

Vitamin B12 deficiency

  • Inadequate intake
  • Increased need
  • Impaired absorption
    Lack of intrinsic factor
    -Pernicious anemia
    Malabsorption
    -Gastric bypass and/or bowel resection
    -Pancreatic insufficiency
    -Crohn Disease
    -Prolonged PPI use
    Inherited errors of Vitamin B12 absorption and transport
    Competition for Vitamin B12
    -Blind loop syndrome
    -Parasites
29
Q

B12 anemia

S/Sx
4 neuro

A

Expect the typical findings of anemia
pallor, fatigue, SOB, palpitations, glossitis etc

Neurological Findings
Ataxia
Decreased vibratory/positional sense
+ Romberg Test
Cognitive impairment (also may occur in folate deficiency)

30
Q
A
31
Q

B12 anemia

labs

A

Screening tests
Complete blood count (CBC) and reticulocyte count
Blood smear examination
RBC and WBC morphology
WBC manual differential
Vitamin B12 level
Folate
Methylmalonic Acid- In certain cases

32
Q

megaloplastic erythropoiesis

A

few or no reticulocytes

howell-jolly bodies

macrocytes with pokilocytosis

hypersegmentation of neutrophils.

33
Q
A
34
Q

b12 and folate

who to test?

A

MCV >100 with or without anemia

Hypersegmented neutrophils on peripheral smear
Gastric bypass surgery
Unexplained neurologic symptoms/signs
Alcoholics / malnourished / elderly
Vegans, if no supplementation
Patients on metformin with new onset neuropathy

35
Q

Pernicious Anemia Deficiency (B12)

Lab Features

A
36
Q

B12 vs Folate Deficiency

A
37
Q

Vitamin B12 Deficiency

Tx

A

Adults
Vitamin B12 1000mcg PO daily
2000mcg daily if poor absorption concerns
Vitamin B12 (Cyanocobalamin) 1000mcg IM inj.
Once per week until deficiency corrected, then once a month
May give up to 3-5 times per week if neurologic symptoms

Children
Vitamin B12 1000mcg PO daily x 1 week, QOD x 1 week, , twice weekly for 2 weeks, and once weekly for 3 months

38
Q

Folate Deficiency

Tx

A

Oral folic acid 1-5mg PO daily for 4 months

39
Q

B12
Tx

A

Cyanocobalamin (B-12) 1000mcg IM daily x 1 week
Then 1000mcg weekly x 1 month (usually once monthly x 2-3 months)
1000mcg monthly for life if specific conditions such as Pernicious Anemia
Oral high dose 1-2 mg daily (usually labeled in mcg)
As effective but less reliable than IM
Sublingual, Nasal spray and gel formulations available

40
Q
A

CMT-dos (95 decks)

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