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Fall 2021: Therapeutics III > Therapeutics of Anemia > Flashcards

Therapeutics of Anemia Flashcards

1
Q

List the 5 signs and symptoms of anemia.

A
  1. exertional dyspnea
  2. angina
  3. tachycardia (compensatory)
  4. fatigue
  5. pallor
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2
Q

What is the normal range of RBCs for men?

A

4.5-5.5 x 106 cells/µL

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3
Q

What is the normal range of RBCs for women?

A

4.1-4.9 x 106 cells/µL

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4
Q

What is the normal hemoglobin (Hgb) range for men?

A

13.5-18 g/dL

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5
Q

What is the normal hemoglobin (Hgb) range for women?

A

12-16 g/dL

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6
Q

What is the normal hematocrit (Hct) range for men?

A

38-50%

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7
Q

What is the normal hematocrit (Hct) range for women?

A

36-46%

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8
Q

What is the normal mean corpuscular volume (MCV) range for both sexes?

A

80-100 mm3

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9
Q

What is the normal mean corpuscular hemoglobin (MCH) range for both sexes?

A

26-34 pg/cell

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10
Q

What is the normal mean hemoglobin concentration (MCHC) range for both sexes?

A

31-37 g/dL

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11
Q

What is the normal RBC distribution width (RDW) range for both sexes?

A

11.5-14.5%

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12
Q

What value is the volume of RBCs per unit of blood?

A

Hematocrit (Hct)

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13
Q

What value describes the average volume of RBCs?

A

mean corpuscular volume (MCV)

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14
Q

What are the 3 main causes of anemia?

A
  1. decreased RBC production
  2. increased RBC destruction
  3. increased RBC loss
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15
Q

What conditions can contribute to decreased RBC production?

A
  • chronic disease (CKD, CHF)
  • nutritional deficiencies (iron, folic acid, B12)
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16
Q

What conditions can contribute to increased RBC destruction?

A
  • drugs (i.e., hemolytic anemia)
  • sickle cell anemia/thalassemia
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17
Q

What conditions can contribute to increased RBC loss?

A
  • acute blood loss
  • chronic NSAID/ASA use
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18
Q

What MCV can be considered microcytic?

A

< 80

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19
Q

What MCV can be considered normocytic?

A

80-100

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20
Q

What MCV can be considered macrocytic?

A

> 100

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21
Q

What conditions are associated with microcytic anemia?

A
  • iron deficiency
  • sickle cell
  • thalassemia
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22
Q

What conditions are associated with normocytic anemia?

A
  • anemia of chronic disease
  • blood loss
  • hemolysis
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23
Q

What conditions are associated with macrocytic anemia?

A
  • folic acid deficiency
  • B12 deficiency
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24
Q

What are the 6 consequences of anemia?

A
  1. impaired cognitive function
  2. increased fall risk
  3. heart failure worsening
  4. atrial fibrillation worsening
  5. cardiovascular events
  6. mortality
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25
Q

What are the 5 goals of therapy associated with anemia treatment?

A
  1. increase Hgb
  2. relieve symptoms (decrease fatigue)
  3. reduce mortality (HF, cognitive impairment)
  4. improve QOL
  5. reduce mortality
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26
Q

What lab values can be increased in iron deficiency anemia?

A
  • RDW (can also be neutral)
  • TIBC/transferrin
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27
Q

What lab values can be decreased in iron deficiency anemia?

A
  • Hgb
  • MCV
  • Ferritin
  • Serum iron (can also be neutral)
  • TSAT
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28
Q

What range is considered normal for ferritin?

A

15-200 ng/mL

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29
Q

What range is considered normal for iron?

A

40-160 mcg/dL

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30
Q

What range is considered normal for transferrin?

A

200-360 mg/dL

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31
Q

What range is considered normal for TIBC?

A

250-400 mcg/dL

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32
Q

What range is considered normal for TSAT?

A

20-50%

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33
Q

Although there is an established normal range for ferritin, iron deficiency is still likely for ferritin below what value?

A

< 45 ng/mL

34
Q

What does it mean if someone is acute phase reactant?

A

ferritin is elevated in acute inflammation or chronic disease

35
Q

According to Dr. Rogers, what are the two most important values to look at in an iron study?

A

ferritin and TSAT

36
Q

What are the 4 main causes of iron deficiency?

A
  1. Blood loss (menstruation, blood donation)
  2. Decreased absorption (celiac disease, gastric bypass)
  3. Vegetarian diet
  4. Increased consumption (like in pregnancy)
37
Q

Where in the colon does maximal absorption occur?

A

duodenum

38
Q

What are the 3 signs and symptoms of iron deficiency anemia?

A
  1. spoon-shaped nails (koilonychias)
  2. inflamed tongue (glossitis)
  3. pica
39
Q

Iron by which route is preferred when treating iron deficiency anemia?

A

oral

40
Q

What are the 3 exceptions to using oral iron for iron deficiency anemia?

A
  • can’t be tolerated (side effects)
  • can’t be absorbed
  • ESRD
41
Q

Although oral iron dosing varies in practice, what are some of the generally accepted doses?

A
  • 65 mg elemental iron QOD
  • 120-200 mg elemental iron daily (often BID or TID)
42
Q

What is hepcidin?

A

an iron-regulating peptide hormone produced in the liver

43
Q

Hepcidin _______ dietary iron absorption and iron transfer to the plasma

A

decreases

44
Q

Hepcidin is increased after a dose of oral iron for ____ hours and normalizes within ____ hours.

A

24; 48

45
Q

Give the tablet strength and elemental iron in mg for ferrous fumarate.

A

300 mg

100 mg elemental iron (33%)

46
Q

Give the tablet strength and elemental iron in mg for ferrous sulfate.

A

325 mg

65 mg elemental iron (20%)

47
Q

Give the tablet strength and elemental iron in mg for ferrous gluconate.

A

300 mg

30 mg elemental iron (10%)

48
Q

Give the tablet strength and elemental iron in mg for polysaccharide iron complex.

A

tablet strength varies

100% elemental iron

49
Q

Give some counseling points for oral iron.

A
  • increased absorption on an empty stomach
  • take with food or split doses to help with stomach upset
  • vitamin C (ascorbic acid) can increase absorption
  • causes constipation
  • causes dark stools
50
Q

What side effects can occur with IV iron?

A
  • hypotension during infusion (common)
  • skin tattooing if it gets outside the vessel (rare)
51
Q

What IV iron product has a risk of anaphylaxis?

A

iron dextran

52
Q

What labs are increased in B12 deficiency anemia?

A
  • MCV
  • RDW
  • Homocysteine/methylmalonic acid
53
Q

What labs are neutral/unchanged in B12 deficiency anemia?

A
  • ferritin/TIBC/transferrin
  • serum iron/TSAT
54
Q

What labs are decreased in B12 deficiency anemia?

A
  • Hgb
  • Serum B12 (< 200)
55
Q

List the four possible causes of B12 deficiency.

A
  1. diet (our bodies can’t make B12)
  2. intrinsic factor (pernicious anemia)
  3. decreased absorption (i.e., Crohn’s)
  4. medication (PPIs, metformin)
56
Q

What is the recommended treatment for B12 deficiency anemia?

A

VITAMIN B12 REPLACEMENT

  • 100-1000 mcg IM or deep SC injections (often daily for 1-2 weeks, then weekly-monthly as maintenance)
  • 1000-2000 mcg/day PO (not as effective)
57
Q

What labs are increased in folic acid deficiency?

A
  • MCV
  • RDW
  • Homocysteine
58
Q

What labs are neutral/unchanged in folic acid deficiency?

A
  • ferritin/TIBC/transferrin
  • serum iron/TSAT
59
Q

What labs are decreased in folic acid deficiency?

A
  • Hgb
  • serum folate (< 5)
60
Q

What are some possible causes of folic acid deficiency?

A
  • malabsorption
  • malnutrition (green veggies, OJ, cereal, flour, milk have folate)
  • alcoholism
  • medications (MTX, phenytoin, sulfasalazine, SMX/TMP)
61
Q

What treatment is recommended for folic acid deficiency anemia?

A

PO folic acid supplement 1-5 mg daily until Hgb normalizes

62
Q

You should NEVER replace folic acid without checking ______.

A

vitamin B12

63
Q

What kinds of conditions can cause anemia of chronic disease?

A
  • CKD
  • CHF
  • Cancer
  • HIV/AIDS
64
Q

When treating anemia of CKD, why should you avoid blood transfusions in patients eligible for kidney transplant?

A

risk of allosensitization

65
Q

What treatment measures are recommended for anemia of CKD?

A
  • folate/B12/iron supplementation (PO iron in stage 3-5 if possible, IV in hemodialysis)
  • ESAs (started after replenishing iron stores)
66
Q

What is the target TSAT when treating iron deficiency in anemia of CKD?

A

> 30%

67
Q

How should ESAs be dosed for anemia of CKD?

A

use minimum dose to maintain Hgb > 10, do not titrate up for at least 4 weeks after initiating/increasing dose

68
Q

What groups of CHF patients may benefit from IV iron?

A
  • NYHA class II/III AND
  • iron deficiency (ferritin < 100 or 100-300 if TSAT < 20%)
69
Q

What trial demonstrated that IV iron supplementation can lead to decreased HF hospitalizations?

A

AFFIRM-AHF

70
Q

Can we use PO iron supplementation in anemia secondary to CHF?

A

nope, IRONOUT-HF showed no benefit

71
Q

Why should ESAs be avoided in anemia secondary to CHF?

A

lack of benefit and increased risk of thromboembolic events

72
Q

When should we consider transfusing packed RBCs (PRBCs) in blood loss anemia?

A

Hgb < 7

73
Q

How much iron is in each unit of PRBC?

A

250 mg

74
Q

Give two examples of inherited hemolytic anemia.

A

sickle cell anemia and G6PD deficiency

75
Q

Give an example of acquired hemolytic anemia.

A

drug-induced

76
Q

In sickle cell anemia, RBCs collect in the _______ and are destroyed faster than can be produced.

A

spleen

77
Q

Is sickle cell anemia dominant or recessive?

A

recessive

78
Q

How should we treat sickle cell anemia?

A
  • folic acid 1 mg/day
  • hydroxyurea 10-15 mg/kg/day (titrated to max 35 mg/kg/day)
  • blood transfusions PRN
  • immunizations (flu, pneumococcal, meningococcal)
  • pain control (APAP/NSAIDs, opioids in pain crisis)
79
Q

Why is hydroxyurea an effective treatment for sickle cell anemia?

A

it is a fetal hemoglobin inducer, and helps make hemoglobin that only infants would produce (less likely to sickle)

80
Q

Why do we need to monitor patients taking hydroxyurea?

A

it is an immunosuppressant

81
Q

What type of drug-induced anemia affects patients with G6PD enzyme deficiency?

A

drug-induced oxidative hemolytic anemia

Fall 2021: Therapeutics III (25 decks)

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