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49 Cards in this Set
- Front
- Back
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How do you calculate hemocrit from hemoglobin levels?
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Hemoglobin * 3 = Hemocrit
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Define: Anemia
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Decreased RBC
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Define: Erythrocytosis
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Increased RBC
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Cardiovascular consequences of anemia
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1) Tachycardia
2) Hypotension 3) Mild cardiac enlargement 4) Functional systolic murmurs 5) High output failure 6) Worsening of HF or other CV disease |
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Pulmonary consequences of anemia
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1) Exertional dyspnea
2) Orthopnea 3) Tachypnea |
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What are the benefits to a RBC transfusion?
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Immediate increase of 1 gm/dL Hg per unit infused
Does not matter what the cause is |
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What are the risks to a RBC transfusion?
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- Infection (rare)
- Transfusion Reactions |
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How do you prevent a transfusion reaction?
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Give acetaminophen and diphenhydramine prior to administration
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How quickly do you perform a transfusion?
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1 unit over 4 hours
Each unit increases hemoglobin 1 gm/dL |
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MCV cutoff for microcytic RBC
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MCV < 80
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MCV cutoff for normocytic RBC
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80 < MCV < 100
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MCV cutoff for macrocytic RBC
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MCV > 100
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In what form is iron stored in the body?
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Ferritin
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What are the three causes of Microcytic anemia?
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1) Iron Deficiency
2) Anemia of Chronic Disease 3) Bone Marrow Biopsy |
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Define: TIBC
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Total Iron Binding Capacity
Iron is needed to hold the cell together |
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What TIBC level indicates iron deficiency?
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TIBC > 444
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How does one treat iron deficiency
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Iron Supplementation
(Mindblow, I know) |
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What is the precursor to the RBC?
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Reticulocyte
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If Normocytic anemia is determined, how do you determine the cause?
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Check to see whether bone marrow is working by a corrected reticulocyte count
If < 0.5% - No new RBC --> Bone Marrow Failure If > 1.5% - New RBC --> Hemolysis, acute blood loss |
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What test diagnoses hemolytic anemia?
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Coomb's Test
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What does a negative Coomb's Test indicate?
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Hemolytic Anemia
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What does a positive Coomb's Test indicate?
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Autoimmune Hemolytic Anemia
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What test diagnoses B12 deficiency?
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Schilling Test
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What is the primary cause of B12 deficiency?
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Poor diet
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What is the primary cause of folic acid deficiency?
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Pregnancy
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What level indicates B12 deficiency?
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B12 < 200 ng/L
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What level indicates folic acid deficiency?
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Folic Acid < 3 ug/L
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When do you use IM B12 supplementation?
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When a Schilling Test comes back abnormal
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How much iron does the body store?
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4 grams
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What type of iron is absorbed?
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Fe+2 - Ferrous
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What type of iron is not absorbed?
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Fe+3 - Ferric
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What is the daily iron requirement for pregnant women?
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3 to 6 mg
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Put these following iron forms in order (from highest to lowest) based upon their elemental iron content:
Ferrous Fumarate, Ferrous Sulfate, Ferrous Gluconate |
1) Ferrous Sulfate (60-65mg)
2) Ferrous Gluconate (37-39mg) 3) Ferrous Fumarate (33mg) |
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Main consoling pearls pertaining to Iron Supplementation therapy
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- Take with meat, fish, poultry or orange juice (not Ca enriched)
- Avoid Ca and Al containing products - Avoid sustained release products |
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Why must someone avoid products containing calcium and aluminum while taking iron supplements?
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They inhibit proper absorption of the iron
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How long will a patient be on iron supplementation therapy?
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3 to 6 months
Hemoglobin increases 1 gm/dL per week |
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Signs of toxicity in iron supplementation
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- Discoloration of feces
- Nausea (very common) - Diarrhea or Constipation |
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What types of iron are used for either IM or IV delivery?
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- Iron Dextran
- Ferrlecit - Venofer |
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How do you know if B12 supplementation is working?
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- Hemoglobin rises in 1 week
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What are the signs of B12 toxicity?
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- Hyperuricemia
- Hypokalemia - Cardiac Events |
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What form of IV iron has the least incidence of allergic reaction?
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Venofer
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What form of IV iron has the most incidence of allergic reaction?
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Iron Dextran
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What are the causes of folic acid deficiency (aside from being pregnant)?
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- Poor dietary intake
- Decreased absorption - Hyperutilization - Inadequate utilization - Drugs |
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How long is typical folic acid replacement therapy?
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4 months
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What drugs are associated with Hemolytic Anemia?
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- Dapsone
- Methyldopa - Penicillins - Sulfonamides |
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What drug class do you use to treat drug induced hemolytic anemia?
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Steroids!
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Name the four treatment options for cancer-associated anemia
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- No therapy
- Correct obvious cause - Red Cell Transfusion - Erythropoietic Growth Factors |
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How do Erythropoietic Growth Factors treat anemia?
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Stimulates EPO which tells the bone marrow to get its butt in gear and make more RBCs
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Name the Erythropoeitc Growth Factors
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- Procrit (Epoetin Alfa)
- Epogen (Epoetin Alfa) - Aranesp (Darbepoetin Alfa) |
