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Hematology > Treatement of Anemia > Flashcards

Treatement of Anemia Flashcards

1
Q

First line therapy of IDA?

A

oral iron

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2
Q

Drawbacks of oral therapy

2

A
  1. Absorption is limited in malabsorptive states and in chronic kidney disease
  2. May not be able to keep up with the bleeding in cases of ongoing blood loss
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3
Q

70% non-compliance rate due to GI side effects. What are they?
7

A 
Constipation
Nausea/vomiting
Diarrhea
Metallic taste
Thick green/black stool
May exacerbate inflammatory bowel disease
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4
Q

Where are iron supplements absorbed?

A

Is not absorbed in the stomach but best in the duodenum and proximal jejunum

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5
Q

How do you decrease the degree of side effects?

A

decrease the dose

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6
Q

What are the kinds of formulas for oral iron administration?

A

Avoid enteric coated or sustained release

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7
Q

When should we eat with iron supplementation?

What are the worst offenders?

A
  1. Give on an empty stomach as most foods impair the absorption 2. (worst offenders are calcium containing foods, cereals, fiber, tea, coffee, eggs, milk)
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8
Q

What meds should we avoid or take at a later time when taking oral supplementation?
2

A
  1. Give 2 hours before or 4 hours post antacids
  2. Calcium significantly impairs absorption
  3. To increase absorption give with Ascorbic acid or orange juice
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9
Q

What could you try if lowering the dose of the pills doesn’t work before going to IV therapy?

A

Ferrous sulfate elixir 44mg/5mL may be better tolerated than the tablets if patients have significant GI upset on the tablets
-rinse mouth out

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10
Q

How much of elemental iron is recommened a day for adults?

A

150-200mg/day of elemental iron

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11
Q

Whats the best option and how much elemental iron does it have?

A

Least expensive is ferrous sulfate 325mg tabs contain 65mg of elemental iron (varies from 300-325 iron salts and 60-65 elemental iron)

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12
Q

HOw much elemental iron is in Ferrous fumerate?

A

67-106 mg

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13
Q

How much elemental iron is in ferrous sulfate (325mg) ?

A

60-65 mg

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14
Q

How much elemental iron is in ferrous gluconate 325mg?

How much elemental iron is in Elixir (ferrous sulfate)?

A

28-37 mg

44 mg/5mL

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15
Q

Duration of therapy?

2

A

Some stop treatment when the Hgb normalizes

Others treat for 6 months after the Hgb has normalized

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16
Q

Whats the advantages and disadvantagses of stopping when it normalizes?

A

could still have a low iron even though the HgB has normalized

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17
Q

If youre giving the iron for pica or RLS how long will it take to go away?

A

often disappears right away

May feel better in a few days

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18
Q

When will reticulocytosis go away with iron treatment?

A

7-10 days

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19
Q

How long will it take for HgB to start getting better and nromalize?

A

Hgb increases slowly after 1-2 weeks of treatment and should rise 2 g/dL at 5 weeks, hgb should normalize in 6-8 weeks

20
Q

How long will it take for smooth tongue to go away with iron?

A

returns to normal in weeks to months

21
Q

Whats an alternative to pills and how should we take this?

3

A
  1. 10 mL of iron sulfate elixir once daily (88 mg elemental iron)
  2. mixed in a small glass of orange juice and taken
  3. 30 min prior to breakfast (reduce the dose to 5 mL if irritation occurs, if unable to drink juice can give with 50-100 mg vitamin C (ascorbic acid)
22
Q

Indications for IV iron?

5

A 
Excessive ongoing blood loss
Inflammatory bowel disease
Chronic kidney disease
Cancer patients
Inability to tolerate oral iron
23
Q

Why is iron IM not recommended?

4

A
  1. PAINFUL,
  2. can stain the skin at injection site,
  3. mobilization of iron from IM sites is slow,
  4. has been associated with gluteal sarcomas
24
Q

What are the kinds of IV iron?

4

A 
Iron Dextran (INFeD) 
Ferris gluconate (ferriecit)
Iron sucrose aka saccharate (Venofer)
Ferumoxytol (Faraheme)
25
Q

If they have any asthma or drug allergy in their history or RA what do you have to medicate with?

A

prednisone

26
Q

What drug could alter MRI results?

A

Ferumoxytol

27
Q

Side effects of IV iron?

5

A 
1. Life threatening adverse drug effects have been seen in all preparations
SE – 
2. fever, 
3. arthralgias, 
4. myalgias, 
5. Rheumatoid arthritis flares
28
Q

How much folic acid should we take daily for a deficiency and for how long?

A

1-5 mg/day

Continue for 1-4 months

29
Q

Why do we need to rule out B12 deficiency before treating folate?

A

Can partially reverse some the hematologic abnormalities of B12 deficiency BUT the neurologic manifestations will progress!

30
Q

How should we treat permanenetly decreased ability to absorb detary B12?
3

A
  1. IV
  2. 1000mcg IM daily for 1 week
    1000mcg IM weekly for 4 weeks
    1000mcg IM once monthly
  3. Or until corrected
31
Q

When is the most appropraite time to try oral replacement of B12?

What kind of preparations that we should avoid?

A

after restoring deficiency with parenteral B12 (1000-2000mcg/day)

Avoid sustained or time released preparations

MUST MONITOR CLOSELY

32
Q

Effects fo therapy:

When will they feel better?

When will reticulocytes go up?

When will HgB rise?

When will neuro symptoms improve?

A
  1. Patient may feel better within a few days
  2. Reticulocytosis noted in 3-4 days
  3. Hgb rises within 10 days and normalizes within 8 weeks
  4. Neurologic abnormalities improve over 3 months and maximum improvement noted at 6-12 months
33
Q

Drugs used to stimulate RBC production?

2

A

Epoetin alfa (Epogen, Procrit)

Darbepoetin alfa (Aranesp)

34
Q

MOA for Erythropoiesis-Stimulating Agents?

A
  1. Induces erythropoiesis by stimulating the division and differentiation of committed erythroid progenitor cells
  2. Induces the release of reticulocytes from the bone marrow
35
Q

Patients disease state really matters when dosing RBC production drugs

A

LOOK them up

36
Q

Indications for Erythropoiesis-Stimulating Agents?

A

Used for the prevention of blood transfusion in the following causes of anemia

37
Q

Examples of when they would need Erythropoiesis-Stimulating Agents?
5

A
  1. Chronic kidney disease hgb
38
Q

HgB level for EPS in Chronic kidney disease on dialysis?

A

below 10 and treat up to 11

39
Q

HgB level for EPS in Chronic kidney disease not on dialysis?

A

below ten and treat up tpt ten

40
Q

HgB level for EPS with cancer?

A

start with hgb

41
Q

HgB levl for EPS with HIV?

A

hgb levels should not >12 g/dL

42
Q

HgB level for EPS in presurgical patients?

A

> 10 mg/dL ≤13 g/dL

43
Q

Dose adjustments in CKD: If Hgb increases by greater than 1 in 2 weeks what do we do?

A

Decrease dose by ≥25%

44
Q

Dose adjustments in CKD: If Hgb does not increase by greater than 4 weeks what do we do?

A

Increase dose by 25%

45
Q

If no response in HgB by how many weeks its not going to work?

Hematology (18 decks)

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