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38 Cards in this Set
- Front
- Back
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Normal Hemoglobin Level for Men
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14 to 18 g/dL
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Normal Hemoglobin Level for Women
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12 to 15 g/dL
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Level of Hemoglobin in Life-Threatening Anemia
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< 6.5 g/dL
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7 Consequences of Anemia
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Pallor, Fatigue, SOB, Worsening of Cardiac Disease, Cardiac Arrest, Shock, Death
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Cardiovascular Effects from Anemia
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Tachycardia, Hypotension, Mild Cardiac Enlargement, Functional Systolic Mumurs (diastolic murmur uncommon), High Output Failure, Worsening of HF or other CV disease
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Pulmonary Effects of Anemia
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Exertional Dyspnea, Orthopnea, Tachypnea
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The Three Steps of Managing Anemia
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1) Determine Acuity, 2) Determine Etiology, & 3) Initiate Therapy
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How is life-threatening anemia treated. What are the benefits? The risks? Outline the Process.
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Blood Transfusion. Benefit: Immediate increase of 1 g/dL Hg per unit infused. Risks: Infection &/or Transfusion Rxns. Process: Informed Consent, Type & Cross, Premed w/ APAP and Diphenhydramine, and Infuse 1 Unit over 4 hrs.
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Define Microcytic, Normocytic, & Macrocytic w/ respect to MCV.
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Microcytic: MCV < 80; Normocytic: MCV 80 to 100; Macrocytic MCV > 100
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99% of the time, microcytic anemia is due to what?
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Iron Deficiency
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What does a negative Coomb's Test suggest as the source of hemolytic anemia?
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A negative Coomb's test is likely to be drug-induced.
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What does a positive Coomb's Test indicate as the source of hemolytic anemia?
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A positive Coomb's test is indicative of autoimmune hemolytic anemia.
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What are the three categories of people most prone to suffer B12 deficiency?
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People who have a poor diet, alcoholics, and elderly patients.
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What are 5 factors that may lead to folic acid deficiency?
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1) Poor dietary intake, 2) decreased absorption, 3) hyperutilization (e.g. pregnancy), 4) inadequate utilization (rare), & 5) drugs (methotrexate, etc.)
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What does a normal Schilling's Test indicate?
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A normal Schilling's Test indicates that a B12 Deficient patient can be effectively treated w/ oral B12 supplementation.
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What does an abnormal Schilling's Test indicate?
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An abnormal Schilling's Test indicated that a B12 deficient patient must be treated with IM B12 supplementation (oral supplements will not be absorbed).
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What does a Schilling Test measure?
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It measures intrinsic factor. Intrinsic factor is in your stomach and you need intrinsic factor to absorb B12.
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% Elemental Iron in Ferrous Sulfate?
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20%
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% Elemental Iron in Ferrous Sulfate Exsiccated?
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30%
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% Elemental Iron in Ferrous Gluconate?
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12%
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% Elemental Iron in Ferrous Fumarate?
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33%
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% Elemental Iron in Ferric Pyrophosphate?
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12%
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% Elemental Iron in Ferrous Carbonate?
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43%
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Approximately what percentage of iron is absorbed upon oral intake?
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10%
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Why should you never recommend sustained release iron products?
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They release their iron in a place where iron cannot be absorbed.
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Approximately how fast will HgB increase w/ iron supplement therapy?
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HgB will increase ~ 1 g/dL per wk
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For how long will someone who has iron deficiency anemia have to take iron supplements?
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3 to 6 months
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How soon will reticulocytosis occur following iron supplementation in patient who have iron deficiency anemia?
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7 to 10 days
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What are the common ADRs of iron supplementation?
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Discoloration of feces, nausea, and constipation (in most people) or diarrhea (in some people)
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What is the problem with use of Iron Dextran for IM or IV supplementation of iron?
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It can cause anaphalaxis.
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What are the two, newer IV iron products?
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Ferrlecit and Venofer
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What is the difference between Ferrlecit and Venofer?
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Ferrlecit is a sodium ferric gluconate complex in sucrose (62.5 mg elemental iron in 5 mL sucrose). Venofer is iron sucrose (100 mg elemental iron in 5 mL water).
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What are the main ADRs of Ferrlicet?
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Hypotension, rash, flushing, GI upset in 10 to 20% of patients
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What are the main ADRs of Venofer?
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Very well tolerated. ADRs include diarrhea, GI upset, and minty taste in less than 5% of patients.
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Treatment for B12 Deficiency
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IM 800 to 1000 mcg/day for 1 to 2 wks, then 100 to 1000 mcg/wk until normal HgB, and then 100 to 1000 mcg/month thereafter.
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What is the treatment for folic acid deficiency?
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1 mg po qd x 4 months
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Name the drugs most associated w/ hemolytic anemia.
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Dapsone, methyldopa, penicillins, and sulfonamides (such as the sulfamethoxazole in Bactrim)
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What is the two step treatment for drug-induced hemolytic anemia?
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1) Stop the drug, & 2) Steroids, such as prednisone (to shut down the immune system, in severe cases)
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