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Fall 2024 > Therapeutics Exam 3 (Anemia) > Flashcards

Therapeutics Exam 3 (Anemia) Flashcards

1
Q

What is anemia?

A

Decrease in red blood cells or hemoglobin (the piece of RBC that carries oxygen)

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2
Q

How do I know if my patient has anemia?

A

Hemoglobin levels

-signs and symptoms
-bloodwork

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3
Q

What are the symptoms of anemia?

A

-Exertional dyspnea (SOB) [not enough oxygen to body]

-Angina [not enough oxygen to the heart]

-Tachycardia [heart tries to compensate for lack of oxygen by pumping out more blood]

-Fatigue

-Pallor (paleness)

*Could be asymptomatic, especially if it occurs slowly and the body compensates

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4
Q

What is hemoglobin?

A

The oxygen carrying capacity of RBC’s

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5
Q

What is a normal hemoglobin range?

A

Men: 13.5-18 g/dL

Women: 12-15 g/dL

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6
Q

What is mean corpuscular volume (MCV)?

A

The average volume of RBCs

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7
Q

What is a normal mean corpuscular volume (MCV)?

A

80-100 mm^3

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8
Q

True or False: Iron supplementation is the first line treatment of anemia

A

Not always!

-Treating with iron will only work if the patient has iron deficient anemia (the most common type of anemia)

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9
Q

What are the causes of anemia?

A

Not making enough RBCs
Body is destroying RBCs too quickly
Loss of RBCs

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10
Q

What could cause decreased RBC production?

A

Chronic diseases (chronic kidney disease, cancer, CHF)

Nutritional deficiency (iron, folic acid, vitamin B12)

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11
Q

What could cause increased RBC destruction?

A

Drugs

Sickle cell anemia/Thalassemia

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12
Q

What could cause increased RBC loss?

A

Acute blood loss

Chronic NSAID/ASA use

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13
Q

A microcytic RBC has a MCV of what?

A

<80
(small)

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14
Q

A normocytic RBC has a MCV of what?

A

80-100
(normal)

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15
Q

A macrocytic RBC has a MCV of what?

A

> 100
(large)

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16
Q

What types of anemia are characterized by microcytic RBC’s?

A

Iron deficiency
Sickle cell
Thalassemia

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17
Q

What types of anemia are characterized by normocytic RBC’s?

A

Anemia of chronic disease
Blood loss
Hemolysis

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18
Q

What types of anemia are characterized by macrocytic RBC’s?

A

Folic acid deficiency
B12 deficiency

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19
Q

What are the consequences of anemia?

A

Impaired cognitive function
Falls
Heart failure
Atrial fibrillation
Cardiovascular events
Mortality

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20
Q

What is the most common type of anemia?

A

Iron deficiency anemia

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21
Q

What are the defining lab values of Iron Deficiency Anemia?

A

Hgb- low
MCV- low
**Ferritin- low
**Transferrin saturation (TSAT)- low

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22
Q

What is ferritin?

A

Indicator of iron stores

-acute phase reactant, is elevated in acute inflammation or chronic disease
-can look higher in hospitalized patients

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23
Q

What are the normal values of Ferritin?

A

15-200 ng/mL

*iron deficiency can still occur when ferritin <45 ng/mL

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24
Q

What is TSAT (transferrin saturation)?

A

Amount of iron ready for erythropoiesis

25
Q

What is the normal value for TSAT (Transferrin saturation)?

A

20-50%

26
Q

What are the causes of iron deficiency?

A

Blood loss (menstruation, blood donation)

Decreased absorption (celiac disease, gastric bypass)

Vegetarian diet

Increased consumption (pregnancy)

Not normally drug induced

27
Q

What are the symptoms of iron deficiency anemia?

A

Spoon-shaped nails
Inflamed tongue
Pica (craving substances with no nutritional value)

28
Q

How do we treat iron deficiency anemia?

A

Give patient iron

-Oral is preferred over IV

-Exceptions to oral:
–Not tolerated
–Not absorbed
–End stage renal disease
–Heart failure

29
Q

How much iron is found in ferrous sulfate?

A

65 mg elemental iron

30
Q

What is the normal amount of iron we will give a patient?

A

65 mg elemental iron every other day

(ferrous sulfate every other day)

31
Q

How long does it take to replete iron stores?

A

3-6 months

32
Q

Why is every other day dosing better than daily when it comes to iron?

A

Hepcidin
-this is an iron-regulating peptide hormone released by the body every time you take a dose of oral iron
-hepcidin decreases oral iron absorption
-therefor, waiting a day before giving the next dose will avoid the hepcidin and ultimately give you the same response as once daily dosing
-every other day dosing is also better tolerated

33
Q

What are the counseling points for iron?

A

-Increased absorption when taken on empty stomach

-Vitamin C increases absorption (ascorbic acid)

-Causes constipation

-Causes dark stools

-Take 2 hours after PPI because they interfere with absorption

34
Q

What are the indications for IV iron?

A

End stage renal disease
Heart failure
Failed oral iron
Malabsorption

35
Q

What are the side effects for IV iron?

A

Hypotension
Skin tattooing

36
Q

What are the defining factors of a Vitamin B12 deficiency?

A

Hgb- low
MCV- high
***Serum B12- low (<200)

37
Q

What B12 level is considered low?

A

<200

38
Q

What are the causes of Vitamin B12 deficiency?

A

Diet related!
-Vegan/Vegetarian
-Alcoholism

Lack of intrinsic factor (pernicious anemia, cannot absorb B12)

Decreased absorption

Medication (PPI’s, Metformin)

39
Q

What are the consequences of B12 deficiency?

A

Neurologic symptoms
(weakness, numbness, cognitive dysfunction)

40
Q

How do we treat B12 deficiency anemia?

A

B12 supplements
-oral or IM/SC injections

41
Q

What is the typical dosing regimen for IM/SC B12?

A

Daily for 1-2 weeks, then monthly, then periodically

42
Q

When using an oral regimen, how much B12 should a patient get per day?

A

1000-2000 mcg/day

43
Q

What are the defining factors of a folic acid deficiency?

A

Hgb- low
MCV- high
**Serum folate- Low (<5 ng/mL)

44
Q

What is considered a low serum folate?

A

<5 ng/mL

*also can consider <10

45
Q

What are the causes of folic acid deficiency?

A

Malabsorption
Malnutrition
Alcoholism
Medications (methotrexate, phenytoin, sulfasalazine, sulfamethoxazole/trimethoprim)

46
Q

How do you treat folic acid deficiency anemia?

A

Oral folic acid supplementation

47
Q

How much oral folic acid should a patient receive per day?

A

1-5mg daily until Hgb normalizes

48
Q

You should never replace folic acid without doing what?

A

Checking B12 first
-folic acid supplements can correct the anemia but the neurological deficits of vitamin B12 deficiency will remain

49
Q

How can chronic kidney disease cause anemia?

A

-Erythropoietin is produced in the kidneys

Anemia occurs because of:
-Decreased erythropoietin production
-Chronic inflammatory state causing anemia of chronic disease
-Nutritional deficiencies

50
Q

How do you treat anemia of chronic disease?

A

Generally just need to treat the chronic disease well

51
Q

How do you treat anemia in chronic kidney disease?

A

-Avoid blood transfusions
-Correct nutritional deficiencies
-oral iron in stage 3-5 if possible
-IV iron in hemodialysis
-Target transferrin saturation is above 30%
-Erythropoiesis stimulating agents (erythropoietin, darbapoietin)

52
Q

What is the target TSAT (Transferrin saturation) in chronic kidney disease?

A

above 30%
*go a little bit higher than 20% minimum in these patients

53
Q

What are our target hemoglobin levels in chronic kidney disease?

A

We do not target normal hemoglobin levels when using ESA’s!!!
-this increases MI risk
*Goal is just to keep Hgb above 10

HOWEVER: we DO target normal levels when giving iron supplementation

54
Q

When can we start erythropoietin stimulating agents (erythropoietin, darbapoietin) in anemia of chronic kidney disease?

A

Only after replenishing iron stores

55
Q

How do we treat anemia caused by heart failure?

A

-Patients may benefit from IV iron if:
-iron deficiency (ferritin <100, or 100-300 if TSAT <20%)

*note that ferritin targets are higher due to state of inflammation

56
Q

What form of iron should be used in heart failure anemia patients?

A

IV only! -although it has not been shown to improve survival

*oral iron has shown no benefit

57
Q

What drug class should be avoided in heart failure associated anemia?

A

Erythropoietin stimulating agents

**these are harmful for HF patients

58
Q

For blood loss anemia, at what Hgb level do we give packed red blood cell transfusions?

A

Hgb < 7

Fall 2024 (10 decks)

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