00 Blood Dyscrasias

Question 1

What are some unique symptoms of Anemia?

Answer 1

Glossitis (inflamed tongue). Koilonychias (thin, concave nails). Pica (craving/eating non-foods)

Question 2

What are the normal ranges for Hemoglobin (Hgb)?

Answer 2

M: 13.5-18
F: 12-16

Question 3

What are the normal ranges for Hematocrit (Hct)?

Answer 3

M: 37-49%
F: 36-46%

Question 4

What is the normal range for Mean Corpuscular Volume (MCV)?

Answer 4

80-100mm3

Question 5

What do the labs look like for Microcytic anemia and what’s the main cause?

Answer 5

Low Hgb/Hct and MCV < 80. Usually d/t lack of iron

Question 6

What do the labs look like for Normocytic anemia and what’s the main cause?

Answer 6

Low Hgb/Hct and MCV: 80-100. Usually d/t blood loss

Question 7

What do the labs look like for Macrocytic anemia and what’s the main cause?

Answer 7

Low Hgb/Hct and MCV > 100. Usually d/t a lack of B12

Question 8

What is the main treatment for Microcytic Anemia?

Answer 8

Iron (IV and PO formulations available)

Question 9

What are the elemental percentages in common PO iron products?

Answer 9

Fumarate (33%) > Sulfate (20%) > Gluconate (10%)

Question 10

Which iron product is first line?

Answer 10

Ferrous Sulfate PO

Question 11

What common DDIs are there with iron products?

Answer 11

Tetracyclines, Fluroquinolones, Levothyroxine, Mycophenolate, Levodopa. Separate all these by 2 hours

Question 12

What is the generic name of Fer-In-Sol?

Answer 12

Ferrous Sulfate PO

Question 13

What is the generic name of Ferretts or Hemocyte?

Answer 13

Ferrous Fumarate PO

Question 14

What is the generic name of Fergon?

Answer 14

Ferrous Gluconate PO

Question 15

What are the common ADRs to all IV iron?

Answer 15

Hypotension (infuse slowly), flushing, rash, and pain

Question 16

Which IV iron product requires a test dose?

Answer 16

Iron Dextran requires a test dose d/t possibility of anaphylactic reaction

Question 17

What is the generic name of Infed?

Answer 17

Iron Dextran (IV)

Question 18

What is the generic name of DexFerrum?

Answer 18

Iron Dextran (IV)

Question 19

What is the generic name of Ferrlecit?

Answer 19

Sodium Ferric Gluconate (IV)

Question 20

What is the generic name of Venofer?

Answer 20

Iron Sucrose (IV)

Question 21

What is a common ADR of blood transfusions for microcytic anemia?

Answer 21

Iron overload –> needs pharmacological management for serum levels > 300 mcg/dL

Question 22

What are the two medications used for Iron Overload?

Answer 22

Desferal (Deferoxamine) - IV formulation. Exjade (Deferasirox) - PO formulation (make into PO suspension, DO NOT chew or swallow whole)

Question 23

What is the generic name of Epogen?

Answer 23

Erythropoeietin (Short-acting formulation) - IV or SQ

Question 24

What is the generic name of Procrit?

Answer 24

Erythropoeietin (Short-acting formulation) - IV or SQ

Question 25

What is the generic name of Aranesp?

Answer 25

Darbopoetin (Long-acting formulation) - IV or SQ

Question 26

When do you initiate and stop Erythropoeietin or Darbopoetin for CKD on HD and not on HD?

Answer 26

On HD: Initiate Hgb < 10, stop when Hgb 11+. | No HD: Initiate Hgb < 10, stop when Hgb 10+

Question 27

What are the contraindications for Erythropoeietin or Darbopoetin?

Answer 27

Uncontrolled HTN

Question 28

What are the ADRs with Erythropoeietin?

Answer 28

Thrombotic events (DVT/PE). Increased seizure risk. HTN. Edema. Bone pain

Question 29

What are the ADRs with Darbopoetin?

Answer 29

Hyper or Hypotension. Chest pain

Question 30

What is the BBW for Darbopoetin?

Answer 30

For CKD: targeting Hgb > 12 is associated with increased mortality and serious cardio events. For cancer anemia: increased mortality and tumor progression; increased risk of thrombotic event - DO NOT use when anticipated outcome is cure

Question 31

What is the primary treatment for Macrocytic Anemia?

Answer 31

B12; folate

Question 32

When would you use IV or PO treatment for Macrocytic Anemia?

Answer 32

IV: if there are neurological complications; cannot absorb/comply; severe deficiencies. PO: for maintenance therapy

Question 33

What is the generic name of Cyanocobalamin?

Answer 33

B12 (pink-ish red in color)

Question 34

When is Cyanocobalamin contraindicated?

Answer 34

Cobalt allergy

Question 35

What is the generic name of Folate?

Answer 35

B9 (folic acid)

Question 36

How is folate usually dosed?

Answer 36

OTC: 0.4-0.8mg tab once daily Rx: 1mg tab once daily

Question 37

What is the definition of neutropenia?

Answer 37

ANC < 500 cell/mm3

Question 38

What is the generic name of Neupogen?

Answer 38

Filgrastim (G-CSF) - colony stimulating factor for neutropenia

Question 39

What is the generic name of Neulasta?

Answer 39

Peg-Filgrastim - colony stimulating factor for neutropenia

Question 40

What is the generic name of Leukine?

Answer 40

Sargramostim (GM-CSF) - colony stimulating factor for neutropenia

Question 41

What is the main ADR seen with colony-stimulating factors for neutropenia?

Answer 41

BONE PAIN; fever, HTN, peripheral edema

Question 42

What is the definition of Thrombocytopenia?

Answer 42

Platelet < 100,000/mm3

Question 43

What is the generic name of Neumega?

Answer 43

Oprelvekin (thrombocytopenia treatment)

Question 44

What is the generic name of Promacta?

Answer 44

Eltrombopag (thrombocytopenia treatment)

Question 45

What is the generic name of NPLATE?

Answer 45

Romiplostim (thrombocytopenia treatment)

Question 46

Which Thrombocytopenia Treatment Agent contains a BBW?

Answer 46

Neumega: Possible anaphylaxis

Question 47

What is the Schilling Test used to diagnose?

Answer 47

Pernicious anemia