Flashcards in 09 Chemotherapy Induced Anemia (CIA) Pak Deck (48)
What is Grade 0 in the Anemia Grading Scale?
Males Hgb: 14-18, Females: 12-16
What is Grade 1 in the Anemia Grading Scale?
Mild. Hgb: 10-normal
What is Grade 2 in the Anemia Grading Scale?
Moderate. Hgb: 8-10
What is Grade 3 in the Anemia Grading Scale?
Severe. Hgb: 6.5-7.9
What is Grade 4 in the Anemia Grading Scale?
Life-Threatening. Hgb: < 6.5
What what Anemia Grade do symptoms usually start?
What are the symptoms associated with Grade 2 (moderate) anemia?
Fatigue. Dyspnea. HA. Palpitations. Chest pain
What is the result of chronic anemia?
Can result in severe organ damage affecting the kidneys, CNS, CVS, lungs, immune system, etc
What is a low baseline hemoglobin level?
Males < 13.5, Females < 13
What are the general steps in the management of CIA?
1) Treat underlying deficiencies (iron, folic acid, vitamin B12). 2) Packed red blood cells (PRBC) transfusion. 3) Erythropoietin-stimulating agents (ESA)
When is transfusion indicted?
ASYMPTOMATIC Grade 3 with comorbidities (CHF; CHD; CVD; chronic pulmonary disease, high risk: progressive decline in Hgb w/ recent chemo or radiation). SYMPTOMATIC Grade 2 (sustained tachycardia, tachypnea, chest pain, dyspnea on exertion, lightheadedness, syncope, severe fatigue preventing work and usual activity
What is the Hgb goal in Asymptomatic Grade 3 anemia w/ comorbidities?
What is the Hgb goal in Symptomatic Grade 2 anemia?
How much will 1 unit PRBC raise Hgb?
By 1g/dL and Hct by 3%
What are the benefits of RBC Transfusion?
Rapid increase in Hgb and Hct. Rapid improvement in fatigue
What are the risks with RBC Transfusion?
Transfusion reactions (hemolytic, febrile, non-hemolytic, lung injury, chest pain, uticaria, etc.). Congestive heart failure. Virus transmission. Bacterial contamination. Increased thrombotic events. IRON OVERLOAD (at risk ~100mL/kg PRBC in lifetime and serum ferritin > 1000 mcg/L)
What are the normal iron levels?
What are the normal ferritin levels?
12-300mcg/L in males. 12-150mcg/L in females
What are the symptoms of Iron Overload?
Non-specific: Lethargy, weight loss, abdominal pain, joint pain
What is the indication for Deferoxamine (Desferal)?
Acute iron intoxication. Chronic iron overload secondary to multiple transfusions
What is the MOA of Deferoxamine?
Complexes with trivalent ions (non-specific) that are removed by the kidneys
How is Deferoxamine (Desferal) administered?
Rate of IV infusion NTE 15mg/kg/hr (to prevent flushing, uticaria, hypotension, and shock)
When is Deferoxamine (Desferal) contraindicated?
Severe renal disease or anuria (renally eliminated)
What are some DDIs with Deferoxamine?
Vitamin C > 200mg/day --> risk of cardiac impairment (rare). Prochlorperazine --> may lead to temporary impairment of consciousness
When is Deferasirox (Exjade) indicated?
Chronic iron overload d/t blood transfusion. PO ONLY
What is the MOA of Deferasirox (Exjade)?
Selectively binds iron which is excreted primarily through the feces
What is the administration of Deferasirox (Exjade) like?
DO NOT chew or swallow whole tablets. Disperse tablet in water, orange juice, or apple juice into a suspension. Take on empty stomach ~30 mins AC
How is Deferasirox (Exjade) supplied?
125mg, 250mg, and 500mg tablets for suspension
What are some DDIs with Deferasirox (Exjade)?
Aluminum-containing antacid can decrease absorption (separate 1hr before 2hr after meals)