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Therapeutics P3 Spring > Anemia > Flashcards

Anemia Flashcards

1
Q

Anemia definition

A

low hemoglobin concentration in the blood (<13 g/dL in men OR <12 g/dL in women)

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2
Q

Normocytic Anemia

A

MCV 80-100
Aplastic anemia
Anemia of chronic disease
CKD
Hemolytic Anemia

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3
Q

Microcytic anemia

A

MCV < 80
- iron deficiency anemia
- thalassemia

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4
Q

Macrocytic anemia

A

MCV > 100
- folic acid deficiency
- Vitamin B12 deficiency
- liver disease
- alcohol
- hypothyroidism
- drugs (sulfonamides, antineoplastics)

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5
Q

Causes of Iron Deficiency Anemia

A

Blood loss
- menstruation
- GI bleed
- hemorrhoids
- medication use (NSAIDs, anticoagulants, corticosteroids)
- iron malobsorption

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6
Q

Serum iron def

A

Fe bound to transferrin

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7
Q

Total iron binding capacity (TIBC)

A

Indirect measurement of the iron binding capacity of serum transferrin

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8
Q

Percent transferrin saturation (TSAT)

A

Ratio of serum iron to TIBC

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9
Q

Serum ferritin

A

the amount of iron stored in the liver, spleen, and bone marrow cells

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10
Q

Iron Deficiency Anemia: iron panel

A

Serum iron: low
TIBC: high
TSAT: low
Serum ferritin: low (most sensitive indicator)

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11
Q

Recommended daily iron allowance

A

Adult males and post menopausal females: 8mg

Menstruating females: 18mg

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12
Q

Food effects on iron absorption

A

Orange juice / ascorbic acid: increases absorption

Milk and tea: decreases absorption

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13
Q

Preferred dosing frequency for oral iron supplementation

A

every other day

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14
Q

Oral iron ADE

A

dark, discolored feces
constipation
nausea
vomiting

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15
Q

Drugs that decrease oral iron absorption

A

Al / Mg / Ca containing antacids
tetracycline and doxycycline
H2RA
PPIs
Cholestyramine

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16
Q

Drugs decreased by iron

A

Levodopa
Methyldopa
Levothyroxine
Penicillamine
Fluoroquinolones
Tetracycline and doxycycline
Mycophenolate

take at least 4 hours apart

17
Q

Indications for IV iron supplementation

A

Malabsorption
Poor adherence or tolerance to PO
Gastric bypass
CKD
Cancer while receiving active chemo

18
Q

IV iron formulations

A

target: 1000 mg total

Iron sucrose
- 200mg IV x 5 days
- subtract 1 dose for each pRBC transfusion received

19
Q

IV iron supplementation ADE

A

cramping
flushing
hypotension
N/V
GI irritation
rash
malaise
arthralgias
myalgias
hypophosphatemia
do not start during active infection

20
Q

Megaloblastic anemia

A

Abnormal DNA metabolism -> Vitamin B12/Folate deficiencies

Presentation
- traditional signs of anemia
- GI (loss of appetite, diarrhea, constipation)
- CNS (paresthesia, loss of coordination, tremors, somnolence, taste and smell abnormalities, irritability)

21
Q

B12 deficiency labs

A

RBC low
Hgb low
Hct low
MCV high
Reticulocyte count low
Serum B12 low
Serum folate eh
Serum methylmalonic acid High
Serum homocysteine High

22
Q

Macrocytic anemia treatment

A

B12 deficiency -> supplementation
Folate deficiency -> supplementation

23
Q

Normocytic anemia

A

anemia of inflammation
- anemia of chronic disease
- anemia of critical illness

24
Q

Diseases causing anemia of inflammation

A

Tuberculosis
HIV
COPD
Malignancies
Gout

25
Q

How to tell Anemia of Inflammation from Iron Deficiency Anemia

A

TIBC

AI: TIBC is low
IDA: TIBC is high

26
Q

Anemia of Inflammation treatment

A

Treat underlying condition
Consider iron supp if pt also has IDA
Erythropoiesis stimulating agents

27
Q

Erythropoiesis stimulating agents

A

Approved for use in AI due to HIV, CKD, anemia of malignancy, and MDS
Agents:
- Epoetin alpha (Procrit, Epogen, Retacrit)
- Darbepoetin alpha (Aransep)
Only effective if iron, B12, and folic acid levels are adequate
Monitor hemoglobin
- DC if Hgb > 12
- hold or decrease dose if Hgb increases > 1 g/dL in 2 weeks

28
Q

Epoetin alpha

A

Short acting ESA
ADE
- fever
- N/V
- HTN
- cough
- pruritis
- rash
- HA
- Arthralgia

29
Q

Darbepoetin alpha

A

Long acting ESA
ADE:
- infections
- blood pressure alterations
- HA
- N/V
- diarrhea
- peripheral edema

30
Q

pRBC transfusions indication

A

consider in acute oxygenation complications of hgb < 7

Therapeutics P3 Spring (32 decks)

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