Onco 2: Anemia (👀 susie..) Flashcards
presentation of anemia
- fatigue
- lighteded/dizzy
- weakness
- exercise intolerance/dysphagia
- HA
- angina/palpiatinos/tachycardia/ischemia
- pale mucous membranes
anemia
decreased ciruclating RBC/Hgb
- female:
- Hgb < 11.9 (ref 12-15)
- Hct < 35% (35-43%)
- male:
- Hgb 13.6 (ref 13.6 - 16.9)
- Hct <40% (ref 40-50%)
Hct
% of RBC to total volume of blood
- low Hct can indicatae:
- decrease in number or size of RBC
- increased plama volume
MCV
mean cell volume: average volume of RBC
- ref 80-100
- low in microcytic
- high in macrocytic
total reticulocyte count
indirect assessment of new RBC productin (immature RBC)
- ref 0.5-1%
- low: impaired RBC productin - B12 deficiency, anemia of inlammation, or renal disease
- high: acute blood loss or hemolysis
macrocytic anemia
B12 or folate deficieny -> RBC canNOT mature -> increase in immature large RBC -> decresase retic count, increase MCV
causes of macrocytic anemia
- pernicious anemia: lack of intrinsic facotr -> inadequate B12 intestinal absorption (pts need lifelong parenteral B12)
- EtOH abuse
- poor malnutrition
- GI disorder
- preggers
- long term use of certain meds (metformin, H2RA, PPI)
macrocytic anemia dx
- low Hgb
- high MCV
- low retic count
- ## low B12 or folate
- MMA: elevated in B12 defiicieny (B12 metabolizes it)
- ref: 0.07 - 0.27
- can be elevavted in hypovolemia and renal disease - homocystene: elevated in B12 OR folate def (they both metabolize it)
- ref: 0-15
- can be elevavted in hypothyrod and renal disease
additional s/s of macroctyic anemia
neuro
- cog imapirment (dementia like)
- gait abnormaltieis
- peripherl neuropathy
B12 deficiency treatmetn
- PO: 1000-2000mcg QD - as efficient as IM in achieiving hemaotologic and neuro response
- IM/SQ 1000 mcg QD 7D then QW 4W then Qmo
- pernicious anemia: B12 inj to bypass absorption
B12 supplemetn ADR
well tolerated
- hyperuriciemia
- hypokalemia
folic acid deficiency treatment
- 1mg PO QD
- if preggers: 0.4-0.8 mg PO QD >1 month prior to gestation and through 12 GWA
- if hx or family hx of NTD: 0.4 mg > 3 months prior to gestation and thorugh 12 GWA
folic acid supplement ADR
well tolerated
- flushing
- malaise
- pruitis
- rash
causes of microcytic anemia
- irond deficiency: decrease in Fe -> decrease in heme -> dysfunctional Hgb -> small RBC, decreased MCV
- sickle cell
- thalessemia: genetic blood disorder, dieifiency of beta chain of Hgb
microcytic anemia dx
- low Hgb
- low MCV
- low retic
- low Fe
- low ferritin
- high TIBC
High TIBC (many Fe binding sites)
ferritin
storage protein that binds to iron and keeps it bound form
- ref 12-150 in female; 15-200 in male
- iron deficiency if < 15, but not ruled out until > 41
- can be elevaeted in inflammaiton (acute phase reactant) -> use TSAT
in iron deficiency, TSAT
- < 16 in pts without inflammation
- 20 in pts wtih
TIBC
basically a transferrin test but not really
- transferrin carries iron in blood -> inerse relaton with ferritin
- decreased ferritin -> decreased Fe storage, icnreased free transferritin
- ref 250-400 (> 400 in iron deficiency anemia)
High TIBC (many Fe binding sites)
goal of treatment for iron deficiecny anemia
increase hgb by 1 Q2-3W, then continue 3-6 months after Fe returns to normal
iron deficiency anemia treatment
- PO iron (preferred): 100-200mg elemental iron
- IV not preferred dt severe ADR and expense, only use if
- CKD on hemodialysis
- CKD with ESA use
- can’t do/failed PO (celiac’s, gastric bypas, achloryddria, H. pylori)
- pt don’t wanna do PRBC
PO iron admin
the following does NOT apply to pure elemental iron (ferric citrate, polysacchraide Fe)
- take on an empty stomach
- needs acidic environemnt for absorption -> avoid H2RA and PPI
iron dextran complex
INFeD
- longest transfusion time
- highest chance of hypersensitivty reaction of the IV Fe (so high that it requires a test dose)
sodium ferric gluconate
Ferrlecit
- risk of benzyl alcohol tox -> avoid in preggers because it can cause premature birht and low birh weight
if must use IV Fe in preggers, use iron sucrose
nomrocytic anemia
epo deficiency (epo comes form kidneys) -> decreased stimulation for bone marrow to produce RBC
common cause of non-hemolytic anemia is CKD
CKD induced anmeia therapy
- Fe
- ESA: helps maintain Hgb levels and reduce need for transfuions, but ineffective if iron stores are low
ESA agens
- epoetin (epogen, procrit)
- darbopoeitin
when to start ESAs in CKD induced anemia
Hgb < 10
BBW for ESAs
- increased risk of death, MI, stroke, VTE, thrombosis
- if CKD, this risk is increased with ESA admin to pts with Hgb > 11
- use lowest effective dose
also do NOT give to chemo pts if the goal of chemo is cure
ESA monitoring
- Hgb QW (in CKD pts, monitor Qmo even after Hgb stabilzies)
- Hct
- TSAT
- serum ferritin
- BP
