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19 Cards in this Set
- Front
- Back
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What blood test is the preferred diagnostic parameter in iron deficiency anemia?
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Serum ferritin
TIBC, Transferrin saturation, serum iron and serum transferrin may be helpful if ferritin is between 46-99 |
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In IDA, MCV will
Hematocrit will Platelet count may Serum ferritin will TIBC will |
Increase
Decrease below 30% Increase Decrease (less than 10 ng/mL in women and 20 in men) Increased > 420 ug/dL |
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When is oral iron therapy used versus transfusion?
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Oral iron therapy should be considered first line, however in patients complaining of fatigue or dyspnea on exertion, as well as those with Hgb < 10 g/dL
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Sustained release iron is not considered part of first line therapy. Why?
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They reduce the amount of iron that is presented for absorption to the duodenal villi
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***It may take up to 4 months for iron stores to correct after Hgb has normalized***
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***GI absorption of elemental iron is enhanced by an acidic environment - This can be accomplished by simultaneous vitamin C intake***
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What are the indications for IV iron therapy?
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Chronic uncorrectable bleeding
Intestinal malabsorption Intolerance to oral iron Hgb < 6 with signs of poor perfusion in patients who would otherwise receive transfusion (eg. religious objections) |
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Name the different iron formulations and describe their mechanisms
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Ferrous sulfate, gluconate, fumarate (Replaces iron in hemoglobin/myoglobin - allows for oxygen transportation)
Dextran, Sodium ferric gluconate (Release iron from plasma, eventually replenishing depleted iron sotres from bone marrow) Iron Sucrose (Dissociates into iron and sucrose - increases serum iron levels) |
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Which formulations are IV versus PO?
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Ferrous sulfate, gluconate, and fumarate are PO
Dextran, Sodium ferric gluconate and Iron Sucrose are IV |
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What are the primary side effects of the oral iron therapies?
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GI irritation
Nausea Dark stools Constipation |
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What drug - drug interactions are pertinent with these agents?
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Decrease the absorption of tetracyclines, fluoroquinolones, levodopa, methyldopa
PPI's and H2 antagonists can decrease iron absorption (need acidic environment) |
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What is the advantage of iron dextran? Disadvantage?
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Can be administered in large doses at one time
Risk of anaphylaxis is greatest ***Test dose should be administered*** |
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What is the common side effect between the IV iron preparations?
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Hypotension
***Iron sucrose and ferric gluconate have similar safety profiles*** |
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In patients with anemia of chronic disease, Hb should be in this range and not above...
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11-12
13 |
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Drug of choice in patients with anemia of chronic disease
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ESA's
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Name the two ESA's and their mechanism of action
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Epoetin alfa (Procrit)
Darbepoetin alfa (Aranesp) ***Induce erythropoiesis by stimulating the division and differentiation of erythroid progenitor cells - induces the release of reticulocytes from the bone marrow into the blood stream*** |
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Primary side effects of ESAs
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Hypertension
Hypotension Peripheral edema Dizziness Diarrhea Infection |
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Contraindications to ESA therapy
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Hgb > 12
Hgb increase of more than 1 g/dL per 2 weeks Uncontrolled hypertension |
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Epoetin indications
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IDA
Sickle cell disease Autoimmune hemolytic anemia Bleeding Chronic renal failure |
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Darbepoetin indications
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Chronc renal failure
Anemia caused by chemotherapy |
