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51 Cards in this Set
- Front
- Back
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True or False: Anemia is a diagnosis.
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False: It is a sign.
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What are three etiologies of anemia?
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Decreased red blood cell production
Increased red blood cell distruction Increase cell loss |
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What are the two classifications of anemia?
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Macrocytic
Microchromic, hyperchromic |
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What causes macrocytic anemia?
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defective maturation, recent blood loss, hemolysis, chronic disease, renal failure, autoimmune, or endocrine
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What causes microchromic or hyperchromic anemia?
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Iron deficiency, sickle cell, or thalassemia
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What labs do you do if you suspect anemia?
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CBC with indices
WBC with differential RBC morphology Bilirubin LDH Serum Iron TIBC Serum ferritin transferin saturation Peripheral blood smear Stool for blood |
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What is the most common anemia?
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Iron deficiency
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What is the most common cause of iron deficiency anemia?
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Blood loss
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Iron is best absorbed in what state?
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Ferric state
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Pregnant, menstruating, or lactating women may require how much iron?
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20mg/day
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Where is iron absorbed?
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in duodenum and jejunum
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For iron therapy, how much ferrous sulfate do you give?
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325 mg tid 65mg(?)
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For iron therapy, how much ferrous gluconate do you give?
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34 mg
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What is the daily adult dose of elemental iron?
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180-200mg
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For iron therapy, when do you expect to see a hematological response? What will you see?
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3 weeks; 2g/dL increase in Hgb
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When does the reticulocyte count increase? When is it normal?
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7-10 days; normal in two weeks
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How long to you continue iron therapy after the Hgb is normalized?
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3-6 months
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True or False: As iron therapy progresses, less iron is absorbed.
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True
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How do you take iron?
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on an empty stomach
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What are the side effects of iron therapy?
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dark stools, iron in stool
GI - Nausea, epigastric pain, constipation, cramping, diarrhea |
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What other drugs does iron interact with?
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antacids - take iron 1 hour before or 3 hours after
tetracycline - take iron 3 hours before or 2 hours after |
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What are some indications for parenteral iron?
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failure to respond to oral therapy
Intolerance to oral therapy Required antacid therapy Significant blood loss in patients refusing transfusion |
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What is the preferred route for parenteral iron?
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Iron dextran (INFeD) IM
--Z-track technique to avoid staining the skin IV - very slow administration |
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What form of iron is FDA-approved for the treatment of iron deficiency anemia in patients undergoing chronic hemodialysis and receiving supplemental erythropoietin
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Iron Sucrose (Venofer)
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What are the side effects of parenteral iron?
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Anaphylactoid reactions (MC with iron dextran)
Hypotension NV Cramps, diarrhea |
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What are the megloblastic anemias?
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B12, folic acid, or a metabolic defect where body can't utilize same.
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Where do humans get B12?
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oysters, clams, liver, kidney
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True or False: It only takes a few month for the symptoms of B12 deficiency to manifest.
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False: It can take 3-5 years for B12 deficiency to manifest.
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What are some causes of pernicious anemia?
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Atrophic gastritis accompanied by reduced intrinsic factor and reduced HCl
Gastrectomy, RA, thyrotoxicosis, and gastric cancer |
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What are some signs and symptoms of pernicious anemia?
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impaired myelin synthesis, weakness, sore tongue, peripheral neuropathy
patients usually feel bad for 6-12 months. Non-specific - tinnitus, neuritis, vertigo, headache, anorexia, pallor, dyspnea (may shadow above) |
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What can give false lows on B12 levels? False highs?
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Low: folate deficiency, transcobolamin deficiency, multiple lyloma, high doses of vitamin C
High: autoimmune, hepatome, leukemias |
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How can you treat pernicious anemia?
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Parenteral B12 (Cyanocobalamin)
Oral B12 |
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What is the dose of parenteral B12 (Cyanocobalamin)?
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30-1000 micrograms IM
--1000 micrograms q week x 4-6 weeks followed by 1000 micrograms per month for lifetime |
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How soon should neurologic symptoms improve with B12 treatment? Hematologic improvement?
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24 hours
1st few days |
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True or False: B12 absorption increases with increasing doses.
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False: Absorption decreases.
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How much B12 needs to be taken to absorb 5 micrograms?
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over 100 micrograms
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Who gets the high doses of oral cyanocobalamin (1000-2000 micrograms)?
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patients who refuse or cannot receive parenteral therapy
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What is the folate requirement?
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50 micrograms/day
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What causes folate deficiency?
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ETOH, rapid turnover, pregnancy
rapid cell turnover |
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What drugs can alter folate metabolism?
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Trimethoprim
Methotrexate Sulfasalazine Oral Contraceptions Anticonvulsants |
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Can large doses of folate reverse the symptoms of pernicious anemia?
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No. Large doses can reverse hematologic aabnormalities but not the neurological symptoms.
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What doses of folic acid can replace storage?
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1mg/day for 2-3 weeks. 5mg where absorption is compromised
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What is the 2nd most common anemia?
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anemia of chronic disease
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What does anemia of chronic disease look like on labs?
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normochromic normocytic or microcytic hypochromic
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Decreased serum iron and TIBC and increased ferritin is seen in what anemia?
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anemia of chronic disease
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True or False: Anemia of chronic disease is life-threatening.
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False: Not usually progressive or life threatening. It's a quality of life issue.
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What are idications for human recombinant erythropoietin therapy?
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Anemia associated with end-stage renal disease
AIDS Cancer Drug-induced anemia Low endogenous EPO levels Autologous blood transfusions for elective surgery |
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Lack of response with EPO therapy is most commonly associated with what anemia?
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iron deficiency anemia
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How do you evaluate the response of EPO therapy?
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increased serum ferritin
decreased transferrin satuation increased corrected reticulocyte count decreased transfusion requirements increase Hgb and Hct |
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What are the side effects of EPO therapy?
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Hypertension
Iron deficiency Seizures |
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What is the advantage of darbepoetin alfa (Aranesp)?
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Half-life 3x longer
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