Anemia

Question 1

Iron deficiency anemia
replace iron
fix underlying problem ie fibroid

Answer 1

tumormcv low= microcytic anemia

retics<2=inadequate production by bone marrow

Question 2

Iron deficiency anemia
generally little iron is lost outside of bleeding
**f/u carefully men and post menopauusal women with iron deficiency anemia

Answer 2

Ferrous sulfate
cheapest/best absorbed (duodenum/upper jejunum) absorption absorption GI SE
po 200-400 =50 -100 mg into hemogloboin

Question 3

Iron absorption

Answer 3

space out dosing for absorption over 6 hour
do not double up doses if missed
Chelation effect (binding)
do not take with dairyother meds/minerals
treat til H&H normal then +2 months (builds back ferratin stores)
hgb > 2 grams q 3 weeks (tx 3-6 months)

Question 4

Ferrous sulfate adverse effects

R/o GI bleed prior (SE black tarry stool)
check well water cooking in iron skillet –possible etiology hemochromatosis

Answer 4

GI effects constipation/ black tarry stools/N&V
Hemochromatosis -Iron overload
deposits in organs– heart/lungs/liver
bronzing skin

Question 5

Ferrous sulfate toxicity pediatric

Answer 5

kids get into parental iron tabs.
provide education
---necrotizing gastroenteritis,bloody diarrhea,lethargy,dyspnea,metabolic acidosis---extreme death
tx chelting (binding) lavage

Question 6

Macrocytic anemia

Answer 6

labs

MCV high cells are big but # of cells are ok.

Question 7

Macrocytic anemia
Folic acid deficiency anemia
Tx stop drinking
folic acid 1 mg daily

Answer 7

Folic acid
given young female multivitamin
pregnancy .need for folate (rapid division of cells require more folate)
HCT> 4-5% weekly
reticulocytes normalize 7-10 day into tx
lifetime treatment with gentic defects and etoh usage

Question 8

Vitamin B12 deficiency/Pernicious anemia

+autoimmune disease > risk (attacks parietal cells-no absorption

Answer 8

labs
hg low, rbc low, MCV high (macrocytic anemia)
Cyanocolbalamin IM injection
100-1000 qod x 7-14 days–100-1000mg q week til H&H normal—100-1000 q month for life
high dose PO - ok but not pperferred

Question 9

Pernicious anemia

Answer 9

treat underlying cause

adverse effects of B12 none but note
with severe pernicious anemia monitor < K+
qd x 7days — 40 meq K+ used for 1 RBC

Question 10

erythropoietin (EPO)

contraindication
hypersensitivity to albumin
uncontrolled HTN (rise in hgb/hct exacerbation of HTN)

Answer 10

stimulates rbc production
rbc production < in chronic renal
Insufficiency (lab cr/cl , 50 ml/min)
Chronic inflammation < epo levels (anemia in chronic disease)

Question 11

erythropoietin (EPO)

Aim for slow rise in hgb
>1gm/dl rise in 14 days = reduction in dose

Answer 11

2 forms
Epoetin Alpha (procrit)
produced by recombinant DNA technology
Darbepoetin EPO–altered to increase half life of alpha x3 (decreased dosing from 3x weekly to weekly)

Question 12

EPO indications

Require adequate nutrition to work
labs iron, folate, b12 normal oncology, nephrology.
Treatment is initiated by specialist

Answer 12

chemo induced anemia
anemia due to renal fialure
anemia of chronic disease
anemia and pt unwilling/unable to get blood

Question 13

EPO Adverse effects

Answer 13

HTN
chest pain
Seizures
allergic reaction (rare)