Treatment of Anemia

Question 1

Iron Supplementation Absorption

Answer 1

Is not absorbed in the stomach but best in the duodenum and proximal jejunum
Take with Food (OJ because acidic) or vitamin C meds
Avoid taking with Calcium containing foods or antacids

Question 2

Iron dosing

Answer 2

Adults: 150-200mg/day of elemental iron

Question 3

Iron Supplements Side effects

Answer 3

fever, arthralgias, myalgias, Rheumatoid arthritis flares

Question 4

Iron Supplement Premedication

Answer 4

Premedication for History of asthma or more then one drug allergy: methylprednisolone 125mg IV
Rheumatoid arthritis: methylprednisolone 125mg IV and 1mg/kg/day of oral prednisone x 4 days after

Question 5

Folic acid deficiency Treatment

Answer 5

1-5 mg/day
Continue for 1-4 months
Need to rule out concomitant B12 deficiency as well

Question 6

B12 (Cyanocobalamin) deficiency Treatment

Answer 6

IV when treating permanently decreased ability to absorb dietary vitamin B12 (pernicious anemia, gastrectomy, surgical removal of the terminal ileum)
Oral replacement of 1000 – 2000 mcg/day seems to be effective even in pernicious anemia due to a secondary transport system that does not need a functioning terminal ileum or intrinsic factor

Question 7

Drugs to stimulate RBC production

Answer 7

Epoetin alfa (Epogen, Procrit) 
Class: Erythropoisis-Stimulating agent (ESA); Growth factor; Recombinant Human Erythropoietin; Colony stimulating factor

Darbepoetin alfa (Aranesp)

Question 8

Erythropoiesis-Stimulating Agents MOA

Answer 8

Induces erythropoiesis by stimulating the division and differentiation of committed erythroid progenitor cells
Induces the release of reticulocytes from the bone marrow

Question 9

Indications for Erythropoiesis-Stimulating Agents

Answer 9

To prevent the need for blood transfusions in the following pt populations

Anemia associated with chronic kidney disease hgb < 10 mg/dL

Anemia due to chemotherapy hgb < 10mg/dL

Anemia due to zidovudine in HIV pts

Anemia in pts scheduled to undergo surgery (not vascular or cardiovascular) hgb between 10 and less then or equal to 13mg/dL

Off label use for anemia secondary to myelodysplastic syndrome

Question 10

Contraindications of Epoetin

Answer 10

Uncontrolled hypertension
History of pure red cell aplasia (due to ESAs)
Allergy to the drug or any component of the formulation