B&l_Maloney: Anemia

Front 1

What are some requirements for RBC Production?

Back 1

Iron
Vitamin B12
Folic acid
Growth factors

Front 2

Which type of deficiency causes a microcytic, hypochromatic anemia?

Back 2

iron deficiency

Front 3

↓ Iron
↓
↓ ????
↓
Microcytic, hypochromic anemia

Back 3

↓ hemoglobin

Front 4

↓Low erythropoeitin levels
↓
↓????
↓
Normocytic, Normochromic Anemia

Back 4

↓ Production of RBCs

Front 5

A deficiency in what can lead to nerve demyelinization and damage?

Back 5

↓ Vitamin B12

Front 6

↓Folic acid & ↓Vit. B12
↓
↓????
↓
MEGALOBLASTIC ANEMIA

Back 6

↓ DNA Synthesis

Front 7

Reduced DNA synthesis is due to ↓ ____ and ↓ ______

Back 7

Folic Acid

Vit. B12

Front 8

T/F

There is an increased requirement for iron during pregnancy

Back 8

True

Front 9

T/F

Blood loss can cause iron deficiency

Back 9

True

Front 10

What would you use for iron deficiency anemia?

Back 10

200 mg elemental iron/day for 3-6 months

Front 11

Why treat iron deficiency anemia with Why 200 mg/day?

Back 11

About 50-100 mg of elemental iron can be incorporated into Hb daily
↓
About 25% of ferrous salt can be absorbed (50mg daily)

Front 12

Oral preparations of irons are also known as _______

Back 12

ferrous salts

Front 13

Which ferrous salt is least irritating to the stomach?

Back 13

Ferrous gluconate

Front 14

Which ferrous salt gives the highest absorption of elemental iron?

Back 14

Ferrous Fumarate
(137mg)

Front 15

What are the Parenteral Preparations of Iron?

Back 15

Iron Dextran

***Iron Sucrose*** --> ON EXAM

Sodium ferric gluconate complex in sucrose

Ferumoxytol

Front 16

Oral iron ineffective
Noncompliance
Anemia of chronic kidney disease**

What would you use?

Back 16

Parenteral Preparations of Iron

Front 17

Why would you get anemia with
chronic kidney disease?

A. Blood loss during hemodialysis
B. Reduced erythropoietin
C. Reduced availability of stored iron
D. Reduced vitamin B12 stores
E. Reduced iron absorption
F. Multiple blood draws

Back 17

A. Blood loss during hemodialysis

B. Reduced erythropoietin

C. Reduced availability of stored iron

E. Reduced iron absorption

F. Multiple blood draws

Front 18

Why would you use parental iron
with anemia from CKD?

Back 18

Iron deficiency anemia is common with CKD, especially those on hemodialysis

Many patients do not respond adequately to oral iron

Front 19

How would you decrease Skin discoloration, local inflammation and pain associated with IM iron?

Back 19

Use z-track injection technique

Front 20

Oral
**GI**
irritation, nausea, diarrhea or constipation

** IM**
Skin discoloration, local inflammation, pain

Adverse effects of?

Back 20

Iron

Front 21

You give a patient iron and later that day they develop arthralgia,backache, myalgia, fever, chills, dizziness, headache, malaise, nausea, and vomiting. What's going on?

Back 21

Delayed hypersensitivity rxn

Front 22

How would you check and see if a patient will have an acute hypersensitivity rxn to IV or IM iron?

Back 22

Give small test dose before giving the full dose

Front 23

-Occurs in children

-Due to its corrosive effects on the GI mucosa

-GI toxicity followed by multiorgan failure

Back 23

Acute Iron Toxicity

Front 24

Treatment for acute iron toxicity?

Back 24

Induce vomiting

Gastric lavage

Deferoxamine (Desferal) Iron chelator

Supportive therapy

Front 25

**Stage of Acute Iron Toxicity**

GI irritation, nausea, vomiting, diarrhea, lassitude, drowsiness, pallor, cyanosis, seizures, shock, coma

Back 25

Stage 1

Front 26

**Stage of Acute Iron Toxicity**

Apparent Recovery

Back 26

Stage 2

Front 27

**Stage of Acute Iron Toxicity**

CNS - lethargy, coma, convulsions

Metabolic acidosis

Hepatotoxicity - necrosis

Renal failure - acute tubular necrosis

Susceptibility to bleeding

Cardiovascular collapse - intractable hypotension, pulmonary edema

Back 27

Stage 3
(Multiorgan Failure)

Front 28

**Stage of Acute Iron Toxicity**

Intestinal obstructions
Pyloric stenosis
Hepatic cirrhosis
Severe gastric scarring

Back 28

Stage 4
(Delayed Effects)

Intestine is scarred and liver is damaged

Front 29

-Excess iron deposits in the heart, liver, pancreas, pituitary and synovia

-Organ failure & death

This describes?

Back 29

Chronic Iron Toxicity

(you really need an underlying dz to get this. It's almost impossible to get from dietary excess)

Front 30

These are causes of?

Back 30

Chronic Iron Toxicity

Front 31

Tx for Chronic Iron Toxicity?

Back 31

Phlebotomy

Deferoxamine (Desferal) – IM or IV

Deferasirox (Exjade) – Oral

Front 32

Deferoxamine

Deferasirox

These are?

Back 32

Iron Chelators

Front 33

What is needed in the GI system to adequately absorb Vit. B12?

Back 33

Acid in stomach

IF

Front 34

What type of things will most likely cause a B12 deficiency?

Back 34

Front 35

Strict Vegans and People on Proton Pump Inhibitors are most likely to develop what?

Back 35

Vit. B12 deficiency

Front 36

Gastric Abnormalities

Pancreatitis

Small Bowel Dz

These Can Lead to?

Back 36

Vit. B12 deficiency

Front 37

If you have adequate stores of B12, but you just had a gastrectomy, how long will it be before you have symptoms of a B12 deficiency without treatment?

Back 37

A couple of years

**Lots of it is stored in the Liver**

Front 38

What are the stores of folic acid like in the liver?

Back 38

Pretty shitty... There isn't a lot

Front 39

What are some things that will cause folic acid deficiency

Back 39

Front 40

If your intake of folic acid suddenly stops, how long will it be before you develop symptoms of a folic acid deficiency?

Back 40

A few months

You don't really store all that much

Front 41

Both Folate and B12 are needed for _________

Back 41

DNA Synthesis

Front 42

A deficiency in what will affect the myelin sheaths of neurons?

Back 42

B12

Front 43

What may happen to
homocysteine levels in a
patient with a folic acid
deficiency?

Back 43

Increase

Front 44

What type of anemia would you
see with either a vitamin B12 or folic
acid deficiency?

Back 44

Megalolastic

Front 45

Why are the red blood cells very
large with a B12 deficiency?

Back 45

Adequate RNA synthesis, but inadequate DNA synthesis

Front 46

Which type of deficiency can cause
nerve demyelination and
neurological symptoms?

Back 46

B12 deficiency

Front 47

Tx for B12 deficiency?

Back 47

Cyanocobalamin or hydroxocobolamin
-Usually FOR LIFE

Oral Folic Acid

Front 48

What may happen if you
treat a vitamin B12
deficiency with large doses
of folic acid?

Back 48

you will correct the anemia but WILL NOT correct nerve damage

Front 49

Name the Hematopoietic Growth Factors

Back 49

Epoetin alfa

Darbepoetin Alfa

Sargramostim

Filgrastim

Pegfilgrastim

Oprelvekin

**No fucking clue how to remember this shit**

Front 50

Analog of erythropoietin with longer half life

This describes?

Back 50

Darbepoetin Alfa

Front 51

**Hematopoietic Growth Factors**

↑RBCS

Back 51

Epoetin alfa
Darbepoetin Alfa

Front 52

**Hematopoietic Growth Factors**

↑Neutrophils

Back 52

Sargramostim
Filgrastim
Pegfilgrastim

Front 53

**Hematopoietic Growth Factors**

↑Platelets

Back 53

Oprelvekin

Front 54

Tx for severe, congenital neutropenia?

Back 54

Filgrastim
Pegfilgrastim

Front 55

Know that the hematopoietic growth factors can treat:

**Thrombocytopenia**
**Anemia**
**Neutropenia**

Associated with AIDS, CKD and Chemotherapy

Back 55

that is all