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PHM 703: Crit Care/Heme/Onc > Onco 2: Anemia (👀 susie..) > Flashcards

Onco 2: Anemia (👀 susie..) Flashcards

1
Q

presentation of anemia

A
  • fatigue
  • lighteded/dizzy
  • weakness
  • exercise intolerance/dysphagia
  • HA
  • angina/palpiatinos/tachycardia/ischemia
  • pale mucous membranes
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2
Q

anemia

A

decreased ciruclating RBC/Hgb
- female:
- Hgb < 11.9 (ref 12-15)
- Hct < 35% (35-43%)
- male:
- Hgb 13.6 (ref 13.6 - 16.9)
- Hct <40% (ref 40-50%)

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3
Q

Hct

A

% of RBC to total volume of blood
- low Hct can indicatae:
- decrease in number or size of RBC
- increased plama volume

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4
Q

MCV

A

mean cell volume: average volume of RBC
- ref 80-100

  • low in microcytic
  • high in macrocytic
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5
Q

total reticulocyte count

A

indirect assessment of new RBC productin (immature RBC)
- ref 0.5-1%

  • low: impaired RBC productin - B12 deficiency, anemia of inlammation, or renal disease
  • high: acute blood loss or hemolysis
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6
Q

macrocytic anemia

A

B12 or folate deficieny -> RBC canNOT mature -> increase in immature large RBC -> decresase retic count, increase MCV

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7
Q

causes of macrocytic anemia

A
  • pernicious anemia: lack of intrinsic facotr -> inadequate B12 intestinal absorption (pts need lifelong parenteral B12)
  • EtOH abuse
  • poor malnutrition
  • GI disorder
  • preggers
  • long term use of certain meds (metformin, H2RA, PPI)
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8
Q

macrocytic anemia dx

A
  • low Hgb
  • high MCV
  • low retic count
  • ## low B12 or folate

  • MMA: elevated in B12 defiicieny (B12 metabolizes it)
    - ref: 0.07 - 0.27
    - can be elevavted in hypovolemia and renal disease
  • homocystene: elevated in B12 OR folate def (they both metabolize it)
    - ref: 0-15
    - can be elevavted in hypothyrod and renal disease
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9
Q

additional s/s of macroctyic anemia

A

neuro
- cog imapirment (dementia like)
- gait abnormaltieis
- peripherl neuropathy

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10
Q

B12 deficiency treatmetn

A
  • PO: 1000-2000mcg QD - as efficient as IM in achieiving hemaotologic and neuro response
  • IM/SQ 1000 mcg QD 7D then QW 4W then Qmo
    - pernicious anemia: B12 inj to bypass absorption
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11
Q

B12 supplemetn ADR

A

well tolerated
- hyperuriciemia
- hypokalemia

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12
Q

folic acid deficiency treatment

A
  • 1mg PO QD
  • if preggers: 0.4-0.8 mg PO QD >1 month prior to gestation and through 12 GWA
  • if hx or family hx of NTD: 0.4 mg > 3 months prior to gestation and thorugh 12 GWA
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13
Q

folic acid supplement ADR

A

well tolerated
- flushing
- malaise
- pruitis
- rash

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14
Q

causes of microcytic anemia

A
  • irond deficiency: decrease in Fe -> decrease in heme -> dysfunctional Hgb -> small RBC, decreased MCV
  • sickle cell
  • thalessemia: genetic blood disorder, dieifiency of beta chain of Hgb
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15
Q

microcytic anemia dx

A
  • low Hgb
  • low MCV
  • low retic
  • low Fe
  • low ferritin
  • high TIBC

High TIBC (many Fe binding sites)

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16
Q

ferritin

A

storage protein that binds to iron and keeps it bound form
- ref 12-150 in female; 15-200 in male
- iron deficiency if < 15, but not ruled out until > 41
- can be elevaeted in inflammaiton (acute phase reactant) -> use TSAT

in iron deficiency, TSAT
- < 16 in pts without inflammation
- 20 in pts wtih

17
Q

TIBC

A

basically a transferrin test but not really
- transferrin carries iron in blood -> inerse relaton with ferritin
- decreased ferritin -> decreased Fe storage, icnreased free transferritin
- ref 250-400 (> 400 in iron deficiency anemia)

High TIBC (many Fe binding sites)

17
Q

goal of treatment for iron deficiecny anemia

A

increase hgb by 1 Q2-3W, then continue 3-6 months after Fe returns to normal

18
Q

iron deficiency anemia treatment

A
  • PO iron (preferred): 100-200mg elemental iron
  • IV not preferred dt severe ADR and expense, only use if
    - CKD on hemodialysis
    - CKD with ESA use
    - can’t do/failed PO (celiac’s, gastric bypas, achloryddria, H. pylori)
    - pt don’t wanna do PRBC
19
Q

PO iron admin

A

the following does NOT apply to pure elemental iron (ferric citrate, polysacchraide Fe)
- take on an empty stomach
- needs acidic environemnt for absorption -> avoid H2RA and PPI

20
Q

iron dextran complex

A

INFeD
- longest transfusion time
- highest chance of hypersensitivty reaction of the IV Fe (so high that it requires a test dose)

21
Q

sodium ferric gluconate

A

Ferrlecit
- risk of benzyl alcohol tox -> avoid in preggers because it can cause premature birht and low birh weight

if must use IV Fe in preggers, use iron sucrose

22
Q

nomrocytic anemia

A

epo deficiency (epo comes form kidneys) -> decreased stimulation for bone marrow to produce RBC

common cause of non-hemolytic anemia is CKD

23
Q

CKD induced anmeia therapy

A
  • Fe
  • ESA: helps maintain Hgb levels and reduce need for transfuions, but ineffective if iron stores are low
24
Q

ESA agens

A
  • epoetin (epogen, procrit)
  • darbopoeitin
25
Q

when to start ESAs in CKD induced anemia

A

Hgb < 10

26
Q

BBW for ESAs

A
  • increased risk of death, MI, stroke, VTE, thrombosis
  • if CKD, this risk is increased with ESA admin to pts with Hgb > 11
  • use lowest effective dose

also do NOT give to chemo pts if the goal of chemo is cure

27
Q

ESA monitoring

A
  • Hgb QW (in CKD pts, monitor Qmo even after Hgb stabilzies)
  • Hct
  • TSAT
  • serum ferritin
  • BP

PHM 703: Crit Care/Heme/Onc (16 decks)

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