Anemia Flashcards
Define anemia in men and women. Which has a higher risk of anemia?
Women: Hgb < 11.9 g/dL OR Hct <35%
Males: Hgb <13.6 g/dL OR Hct <40%
Women more likely to have, geography and age also affects
What are some sx of anemia?
Fatigue
Dizziness
Weakness
Dyspnea on exertion
Headache
Angina
Tachycardia/palpitations
Pale mucous membranes
Ischemia
What labs should be measured to diagnose anemia? What are the normal levels?
RBCs
Hgb (male NL = 13.6-16.9 female NL = 12-15)
Hct (male NL = 40-50% female NL = 35-43%)
Low Hct = Reduction in # or size of RBCs OR increase plasma volume
MCV (mean cell volume) (NL = 80-100 fL)
[microcytic - low volume, macrocytic - high volume]
Total reticulocyte count (NL = 0.5 - 1%)
What is total reticulocyte count?
Assesses new RBC production
(when you bleed -> stimulates increased RBC production -> increased TRC)
Low = impaired RBC production
High = acute blood loss
What causes macrocytic anemia?
Vit B12 or FOLATE deficiency (or both)
Vit B12 deficiency = PERNICIOUS ANEMIA
(Lack of intrinsic factor for B12 absorption)
(Requires lifelong parenteral B12 supp)
Other:
EtOH, poor nutrition, GI disorders, Pregnancy, long term metformin/acid reducer use
What labs are seen in MACROCYTIC anemia?
Low Hgb
High MCV
Low Reticulocytes
Low B12 or folate
Methylmalonic acid [elevated in B12 deficiency anemia only!]
Homocysteine [increased in B12 and folate anemia]
What is the clinical presentation of B-12 macrocytic anemia?
Jaundice
Leukopenia/thrombocytopenia
NEURO
- Cognitive impairment like dementia
- Gait abnormalities
- Peripheral neuropathy
How do you treat B-12 deficient macrocytic anemia?
Oral or IM/SQ B12 (cyanocobalamin)
SQ is Rx only, oral is OTC
po is as effective as injectable
Rare AEs: hyperuricemia, hypokalemia
Dietary B12 = meats, dairy, eggs, fortified cereal
How do you treat folic acid deficient macrocytic anemia? What are possible AEs? What is the duration of therapy?
Normal - oral 1 mg daily (Rx only)
Pregnant:
prevention = 0.4 -0.8mg/day
Family hx of neural tube defects = 4 mg/day
Rare AEs - Flushing, malaise, pruritis/rash
For normalizing RBC count, continue therapy for ≥ 4 months
What are the causes of microcytic anemia?
Iron deficiency
Sickle cell anemia
Thalassemia (genetic deficiency of B-chains in Hgb)
What are some diagnostic labs for microcytic anemia?
Ferritin - storage for iron (male NL = 15-200, female NL = 12-150)
- Iron-deficiency anemia < 15 but below 41 could also be anemic
- can be elevated in inflammation (use TSAT instead)
Serum Total Iron Binding Capacity - Transferrinin levels
(Inverse relationship with ferritin, it carries iron in BLOOD)
NL = 250-400 mcg/dL
Elevated in iron deficient anemia! [ >400]
TSAT (transferrin saturation)
NL = 25-45%
Iron deficiency anemia level <15%
Low Hgb
Low MCV
Low reticulocytes
Low iron/ferritin/TSAT
What is the treatment of iron-deficient microcytic anemia? Should the iron be taken with or without food? What else can be taken to enhance absorption? How long should it be used after normal Hgb achieved?
100-200 mg elemental iron/day
take on EMPTY stomach, need acidic environment
Increase vitamin C for enhanced absorption
Goal: increase Hgb 1g/dL q2-3 weeks, use iron 3-6 months after normal
Name the THREE iron products that must be taken on an empty stomach and what % elemental iron they are. (Microcytic anemia)
Ferrous gluconate (12%)
Ferrous sulfate (20%)
Ferrous fumarate (33%)
Name the TWO iron products that DO NOT have to be taken on an empty stomach and what % elemental iron they are. (Microcytic anemia)
Ferric citrate (100%)
Polysaccharide iron complex (100%)
Most people only take oral iron supplementation, however who SHOULD receive IV iron (microcytic anemia)?
CKD patients on HEMODIALYSIS
CKD patient on erythropoietin-stimulation agents (ESAs)
Unable to tolerate oral iron
Patients who refuse blood transfusions
