850- Anemia Flashcards

Question

Parenteral Iron (Microcytic Anemia - Iron Deficiency) | IV Iron preparations

Answer 1

1. Iron dextran (INFeD) 2. Iron sucrose (Venofer) 3. Ferric carboxymaltose (Injectafer) 4. Ferric pyrophosphate citrate (Triferic) 5. Ferumoxytol (Feraheme) 6. Sodium ferric gluconate (Ferrlecit)

Answer 2

1. Fatal anaphylactic reactions (although rare) have been reported with all formulations of IV Fe - Highest rates observed with iron dextran >> Require 25 mg test dose prior to first dose - Observe patients during and immediately following administration for at least 30 minutes (60 minutes for iron dextran) and until stable - Crash cart and personnel available to provide treatment 2. Arthralgias, arthritis, lower back pain 3. Hypotension - Slow infusion rate - Decrease dose 4. Iron overload - Excess iron can deposit in the tissues → heart, pancreas, and liver dysfunction - Evaluate holding iron when ferritin >500 ng/mL 5. Avoid administering IV iron during active systemic infections

Answer 3

3 major causes: 1. Inadequate intake: may occur in strict vegans (and their breast-fed infants), chronic alcoholics, and elderly patients who consume a “tea and toast” diet 2. Malabsorption syndromes: loss of intrinsic factor (which is required for B12 absorption in small intestines) by autoimmune mechanisms (pernicious anemia), chronic atrophic gastritis, stomach surgery >> Metformin use for 2 or more years – intestinal bacterial overgrowth >> PPI use for 2 or more years 3. Inadequate utilization Can cause neurologic dysfunction: cognitive impairment, peripheral neuropathy

Answer 4

1. Results in tongue and oral ulcerations, changes to skin hair and fingernail pigmentation 2. Causes: - Inadequate intake – poor eating habits, making more common in elderly, teenagers (whose diets consist of “junk food”), alcoholics, food faddists, impoverished, and those who are chronically ill or demented - Decreased absorption – malabsorption syndromes or those who have received certain drugs - Increased folate requirements – pregnant women, patients with hemolytic anemia, malignancy, chronic inflammatory disorders (Crohn’s, RA, psoriasis) patients undergoing long-term dialysis, burn patients, adolescents and infants during growth spurts

Answer 5

- Inhibit DNA synthesis: azathioprine, 6-mercaptopurine, 5-fluoruacil, hydroxyurea, zidovudine - Folate antagonist – methotrexate, pentamidine, trimethoprim - Decreased folic acid absorption – phenytoin, phenobarbital, primidone

Answer 6

1. LOW hemoglobin and HIGH MCV | 2. LOW serum levels of B12 and/or folate

Answer 7

1. Vitamin B12 Deficiency | 2. Folic Acid

Answer 8

1. Early treatment is paramount, if not corrected within months, neurologic effects may be irreversible 2. Oral vitamin B12 (1000 – 2000 mcg) as effective as parenteral IM injections 3. Oral vitamin B12 supplementation is effective in patients with pernicious anemia due to presence of alternate passive absorption pathway for B12 that is independent of intrinsic factor. Patients with pernicious anemia need lifelong vitamin B12 supplementation 4. Dose: B12 1000 to 2000 mcg po daily for 1-2 weeks then 1000 mcg po daily 5. B12 injections first line for patients with severe deficiency or neurological symptoms - Dose 1000 mcg IM daily x 1 week, then weekly for 1 month, then monthly for maintenance. - Daily oral cyanobalamin may be administered after symptoms resolve and hematologic indices have normalized 6. Intranasal B12 spray (Nascobal®) efficacy has not been well studied, therefore should only be used for maintenance therapy after hematologic parameters have normalized and absence of nervous system symptoms 7. Adverse effects rare

Answer 9

* 1 mg po daily, deficiency related to malabsorption 1-5 mg po daily * Parenteral folic acid available, rarely necessary * Therapy continued for about 4 months, long-term folate administration may be needed with chronic conditions or if underlying cause of deficiency cannot be identified/corrected * Adverse effects – not reported, considered nontoxic at high doses, rapidly excreted in urine * Folic acid supplementation in women (who may become/plan to become pregnant) – minimum of 0.4 mg (400 mcg) po daily

Answer 10

Primarily due to deficiency in erythropoietin (EPO): 1. Hormone produced by kidneys that stimulates bone marrow to produce RBC 2. Assess iron labs first, if low administer iron supplement 3. KDIGO guidelines recommend iron therapy if TSAT is ≤30% and ferritin levels are ≤500 ng/mL 4. Erythropoiesis- Stimulating Agents (ESAs) may be considered in patients with Hgb < 10 g/dL

Answer 11

1. Optimize iron first to improve ESA response 2. Epoetin alfa = Epogen, Procrit 3. Darbepoetin alfa = Aranesp 4. Methoxy polyethylene glycol epoetin beta = Mircera 5. May be administered SC/IV 6. Adverse effects - Common: hypertension, headaches - Serious: increased risk of mortality MI, stroke, and thromboembolism; seizures; pure red cell aplasia - CKD: increase risk of death, serious cardiovascular events and stroke when target Hgb >11 g/dL; use lowest effective dose to reduce the need for blood transfusion - Cancer: Shortened overall survival and/or increased risk of tumor progression or recurrence (especially solid tumors); not indicated when the anticipated outcome is cure

Answer 12

o Newer term used to describe anemia of chronic disease and anemia of critical illness o Inflammation underlying etiology o Common in elderly o Diagnosis usually one of exclusion o Anemia of chronic disease observed in patients that lasts longer than 1-2 months o Common causes of anemia of inflammation o Treatment of Anemia of Inflammation

Answer 13

1. Chronic infections: - Tuberculosis - HIV - Osteomyelitis 2. Chronic inflammation - Rheumatoid arthritis - Systemic lupus erythematosus - Inflammatory bowel disease 3. Malignancies

Answer 14

1. Treat underlying cause 2. RBC transfusion - Typically considered for patients with severe anemia (Hg <7-8 g/dL) >> Risks: blood-borne infections, development of autoantibodies, transfusion reactions, iron overload

Answer 15

1. Bone marrow fails to make enough RBC, WBCs, and platelets 2. Causes: - Drugs (Chemotherapeutics – alkylating agents, antimetabolites, antimitotics); some antibiotics, carbamazepine, methimazole, propylthiouracil - Infectious diseases - Autoimmune disorders 3. Risk of developing life-threatening infections or bleeding

Answer 16

1. Immunosuppressants 2. Blood transfusions 3. Stem cell transplant 4. Eltombopag (Promacta) = thrombopoietin nonpeptide agonist - Approved for treatment of severe aplastic anemia in patients unresponsive to immunosuppressive therapy

Answer 17

1. RBC destroyed and removed from bloodstream before their normal lifespan of 120 days 2. Acquired: drug-induced, associated with immune disorder 3. Inherited (sickle cell disease, glucose-6-phosphate dehydrogenase deficiency) 4. Drug induced hemolytic anemia - One mechanism involved medication binding to RBC surface and triggering development of antibodies that attack the RBC - This autoimmune reaction can persist for several weeks even after the medication has been discontinued 5. Direct Coombs test is used to detect antibodies stuck to the surface of RBCs

Answer 18

- Beta-lactamase inhibitors - Cephalosporins - Levodopa - Methyldopa - Penicillins: since 2008, piperacillin is the single most common drug to cause drug-induced hemolytic anemia - Platinum-based chemotherapy agents (carboplatin, cisplatin) - Quinidine - Quinine - Rifampin - Ribavarin

Answer 19

- X-linked inherited disorder - G6PD is an enzyme that protects RBCs from harmful substances (for example reactive oxygen species) - With G6PD deficiency RBCs hemolyze 24-72 h after exposure to oxidative stress - Infections, certain foods (fava beans) severe stress, certain drugs are factors that can increase risk of hemolysis - When hemolysis is severe – patients present with weakness, tachycardia, jaundice, hematuria - Symptoms self-limiting and usually resolve after 8-14 days - High risk medications (if used, should be monitored closely and discontinued if hemolysis develops.)

Answer 20

1. Chloroquine 2. Dapsone 3. Methylene blue 4. Nitrofuantoin 5. Primaquine 6. Probenecid 7. Sulfonamides

850- Anemia Flashcards

(44 cards)