Anemia

Question 1

Microcytic anemia definition

Answer 1

<80 fL

Question 2

Causes of microcytic anemia

Answer 2

IDA

Question 3

IDA causes

Answer 3

Blood loss, iron malabsorption

Question 4

Significant finding for IDA in iron panel

Answer 4

Serum ferritin and MCV are decreased

Question 5

IDA treatment

Answer 5

Diet: increase intake of foods high in iron (8mg/day for adult males and postmenopausal females, 18mg for menstruating females)

Iron supplementation

Question 6

Iron supplementation products

Answer 6

Ferrous sulfate
Ferrous gluconate
Ferrous fumarate

Question 7

Iron supplementation dosing frequency

Answer 7

QOD with ascorbic acid to increase PO absorption

Question 8

PO iron/DDIs: drugs that decrease iron absorption

Answer 8

Al/Mg/Ca-containing antacids
TTCs, doxycycline
H2RAs
PPIs
Cholestyramine

Question 9

PO iron DDIs: drugs decreased by iron

Answer 9

Levodopa
Methyldopa
Levothyroxine
Pencillamines
FQs
TTC, doxycycline
MMF

Question 10

Indications for IV iron therapy

Answer 10

Malabsorption
Poor oral adherence or tolerance
Gastric Bypass
Chronic Kidney Disease
Cancer while receiving active chemotherapy

Question 11

IV iron drugs available

Answer 11

Iron sucrose
sodium ferric gluconate
ferric carboxymaltose
iron dextran
ferumoxtyol

Question 12

ADEs of IV iron

Answer 12

Cramping
Flushing
Hypotension
Nausea
Vomiting
GI irritation
Rash
Malaise
Arthralgias
Myalgias
Hypophosphatemia
Infection??

Question 13

ADEs of PO iron

Answer 13

Dark, discolored feces
Constipation
Nausea
Vomiting

Question 14

Typical IV iron dosing

Answer 14

Iron sucrose 200mg IV x5 days

Decrease dose by 1 day’s worth if previously received pRBC transfusions

Question 15

Macrocytic anemia definition

Answer 15

> 100 fL

Question 16

Causes of macrocytic anemia

Answer 16

Folic Acid Deficiency
Vitamin B12 Deficiency
Liver Disease
Alcohol
Hypothyroidism
Drugs (Sulfonamides, Antineoplastics)

Question 17

Causes of Vitamin B12 deficiency

Answer 17

Inadequate intake from diet, malabsorption syndrome

Question 18

Significant findings for Vitamin B12 deficiency on iron panel

Answer 18

Serum folate unchanged
MMA and homocysteine is increased

Question 19

Vitamin B12 deficiency anemia treatment

Answer 19

Vitamin B12 supplementation PO or IM/SQ, dietary intake

Question 20

PO vitamin B12 dosing

Answer 20

1000-2000mcg QD

Question 21

IM/SQ vitamin B12 dosing

Answer 21

1000mcg QD x1 week, then 1000mcg qweek x4 weeks, then 1000mch qmonth

Question 22

Vitamin B12 side effects

Answer 22

Hyperuricemia, hypokalemia

Question 23

Suggested dietary intake of vitamin B12

Answer 23

0.4mcg/day

Question 24

Folate deficiency anemia causes

Answer 24

Inadequate intake, decreased absorption, increased folate requirements (so you’re not getting enough)

Question 25

Folate deficiency findings on iron panel

Answer 25

Decreased folate, UNCHANGED MMA, increased homocysteine

Question 26

Folate deficiency anemia treatment

Answer 26

PO supplementation

Question 27

Folic acid in most patients

Answer 27

1mg PO QD

Question 28

Folic acid in pregnancy

Answer 28

4mg PO QD

Question 29

Folic acid AEs

Answer 29

Well-tolerated, could have flushing, malaise, pruritus/rash

Question 30

Normocytic anemia definition

Answer 30

80-100 fL

Question 31

Causes of normocytic anemia

Answer 31

Aplastic Anemia Anemia of Chronic Disease Chronic Kidney Disease (CKD) Hemolytic Anemia

Question 32

Significant finding for AI on iron panel

Answer 32

Decreased TIBC (will separate it from IDA)

Question 33

AI treatment

Answer 33

Treatment of underlying condition causing chronic inflammation ESAs pRBC transfusions

Question 34

ESAs in AI

Answer 34

Epoetin alfa, darbepoetin alfa

Question 35

Epoetin alfa AEs

Answer 35

fever, N/V, hypertension, cough, pruritus, rash, headache, arthralgias

Question 36

Darbepoetin alfa AEs

Answer 36

infections, blood pressure alternations, headache, nausea/vomiting, diarrhea, peripheral edema

Question 37

Half-life of epoetin alfa

Answer 37

9 hours

Question 38

Half-life of darbepoetin alfa

Answer 38

25 hours

Question 39

ESA treatment is only effective when what?

Answer 39

Bone marrow has adequate stores of iron, B12, and folate

Question 40

ESAs: when to D/C

Answer 40

Hgb >12g/dl

Question 41

ESAs: when to hold or decrease dose

Answer 41

Hgb >1g/dl in 2 weeks

Question 42

AI treatment in patients with malignancy

Answer 42

Determine underlying cause and treat it Iron supplementation

Question 43

When to consider pRBCs in AI treatment

Answer 43

acute oxygenation complications or Hgb <7g/dl