pharmacotherapy of anemia Flashcards
What is the most common anemia worldwide
IDA (Iron deficiency)
Most common causes of IDA
Blood loss (GI bleed and menstrual)
Deficient diet
Decreased iron absorption
Pregnancy/crohn’s disorder
Symptoms of IDA
Fatigue, dyspnea, cognitive impairment, pica, koilonychia
Lab finding of IDA
Microcytic, hypochromic RBCs
Low MCV
Low Iron
Low Ferritin
High TIBC
High RDW
Which vitamin do you add to oral iron supplementation to improve iron absorption
Vitamin C
Why do plant foods and foods with fortified iron lead to iron deficiency for vegans?
Plant foods are nonheme iron with poor absorption, but meat and pultory has heme iron which is good absorption
When is IV iron indicated
- In severe anemia (Hgb <7.8g)
- Patients who can’t take oral therapy ( throw up/gastric upset)
- Gastric bypass (Cannot absorb it)
Which oral iron therapy should you give? Which dose/days?
40-80mg of elemental iron on ALTERNATE days (monday, wednesday, friday) (every other day)
Prevents side effects, allows the absorption since there is less hepcidin release
Folate deficiency causes
Inadequate dietary intake, decreased absorption, pregnancy, inflammation, dialysis
Vitamin B12 deficiency causes
Inadequate dietary intake, decreased absorption
Pernicious anemia
Decreased intrensic factor causes decreased absorption of Vitamin B12
Folate replacement and treatment
Folic acid PO or IV or IM if PO not working
B12 replacement and treatment
oral replacement of cyanocobalmin
Or injectible
2 products with short half life for EPO
Epoetin alpha and beta
2 products with long half life for EPO
Epoetin B pegol and Darbopetin
Most common genetic disease in USA
Sickle cell disease
What populations are impacted by sickle cell disease
SCD affects 100,000 americans
1/365 african american births
1/16,300 hispanic births
In africa, 75% of SCD there, and 1k people born there per day with SCD
What does the change of glutamic acid to valine cause
Forms Hb-S- B chain is abnormal and replaced by Hb-S.
What is the RBC lifespan of normal RBCs vs CKD, vis SCD
Normal- 120 days
CKD- 60 days
SCD- 10-30 days
3 emergent clinical manifestations of SCD
- Reduced splenic function (clump of RBCs in spleen)
- Aplastic crisis ( Cause severe anemia and cardio decompensation)
- Hemolytic crisis ( decrease in Hgb, decrease in reticulocytes, increased bili, increased LFTs)
After a child looses their spleen due to SCD, what organisms are we most concerned about
Prone to sepsis with encapsulated organisms (Pneumococcus, salmonilla)
What is the leading cause of death in SCD
Acute chest syndrome
Caused by pulmonary vaso occlusion, fluid goes into lung
What does hydroxyurea do
Lower WBC, increase HgbF (above 20)
Modify severity of disease, decreases polymerization and increases nitric acid
When can you start hydroxyurea on SCD patients
9 months old
