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Flashcards in anemia Deck (77):
1

Red blood cells last how long

120 days

2

About how many RBC are produced each day

About 200 million
released into peripheral blood

3

What is anemia?

A condition characterized by a decrease in Hgb or RBC

4

How is anemia classified? (3)

• Mild = hgb 10-12
Moderate = 8- 12
severe- <8

5

Morphological Classes of anemia? (3)

– Megaloblastic
normocytic
microcytic

6

Megaloblastic are what?

large nucleated RBC precursors

7

What is megaloblastic usually associated with?

Typically associated with folic acid or vit B12 deficiency
inadequate intake
decreased absorption
inadequte utilization

8

Microcytic RBC are what?

Small RBC

9

Microcytic anemia is usually associated with?

Typically associated with iron deficiency due to
inadequate iron intake
inadequate iron absorption
increased iron demand
blood loss
chronic disease

10

lack of 3 nutrients to make RBCs that could cause anemia?

– Iron
– Folic
--vit B12

11

what can cause a loss of RBC that could cause anemia?

– Hemorrhage
– Hemolytic

12

Etiology Reduced lifespan of RBC

– Chronic diseases
hemolysis

13

Lack of stimulus to make RBC's
Lack of ability to make RBC

stimulus= decreased erythropoiten production
make= impaired bone marrow function

14

Acute onset of anemia consists of 3 symptoms

Tachycardia, lightheadedness, breathlessness

15

6 symptoms of chronic anemia?

Fatigue, H/A
vertigo, faintness, cold sensitivity,
pallor, loss of skin tone

16

What are some diagnostic labs for anemia?

• CBC, WBC, HCT, Hgb, platelets
stool guiac
peripheral blood smear
reticulocyte count
mean corpuscular volume
mean corpuscular hemoglobin conc
mean corpuscular hemoglobin

17

Iron deficiency Anemia

• Results from a negative iron balance
very small amount of iron are eliminated each day

18

What are some symptoms of iron deficiency

spooning of nails
brittle nails
cheilosis
fatigue
pallor

19

Risk factors of iron deficiency anemia

– Premature infants
children in rapid growth periods
pregnant and lactating women
after gastrectomy
menstruation
GI bleed
chronic hemodialysis

20

Labs seen in patients with iron deficiency anemia

– Low MVC
Low MCHC, MCH
Low serum ferritin
Low transferrin saturation
increase TIBC
increase transferrin

21

What is TIBC

increase amount of iron able to bind to transferrin

22

Why is there low transferrin saturation in iron def anemia?

due to less iron to transport on more transferrin available

23

what are 4 goals to treatment of iron deficiency anemia?

– Alleviate symptoms
correct iron def
increase Hgb
prevent recurrence

24

What needs to be included in someone with iron def anemias DIET?

– Meat, fish, poultry
plant sources are more difficult for body to extract iron

25

What are 4 types of oral supplements used for treatment of iron deficiency anemia?

• Ferrous sulfate** (60 mg elemental)
ferrous gluconate (37)
ferrous fumarate (33)
polysaccharide iron complex (100)

26

What is the aim for oral iron supplements?

Approximately 200 mg/day elemental iron

27

Parenteral Iron is used in cases of? (3)

– iron malabsorption
intolerance oral therapy
chronic non compliance

28

What are some examples of parenteral iron? (4)

iron dextran
sodium ferric gluconate (ferrlecit)
iron sucrose (venofer)
ferumoxytol (feraheme)
all given IV
used for maintence and prevention

29

How do you monitor iron deficiency anemia?

weekly CBC, iron panel, Hgb

30

What should you expect to see in the first few weeks of treatment for iron deficiency anemia?

see increase in reticulocyte count within 7 days due to increase RBC synthesis
increase in Hgb in 1-2 weeks
3-6 months to normalize everything

31

Side effects of iron treatment includes? (4)

Nausea
black tarry stools
ab discomfort
constipation or diarrhea

32

Symptoms of Vitamin B12 def anemia? (5)

– Typical symptoms of anemia
– Neuropsychiatric abnormalities
– Paresthesias
– Ataxia
– Memory loss

33

What does vit B12 deficiency anemia result from? (3)

– Chronic low dietary intake over years
– Poor absorption due to lack of intrinsic facto rin gastric cells
– Contributing conditions may include Whipple disease, Zollinger‐Ellison syndrome, Tropical sprue, gastrectomy, inflammatory bowel disease

34

Labs seen in pts with vit B12 deficiency anemia?

– Macrocytosis/megaloblastic cells
increase MCV
- low Hgb
low serum B12
schilling test
increase homocysteine and methylmalonic acid

35

What are 3 goals of treatment for vit B 12 deficiency anemia

– Resolve symptoms
increase Hgb
prevent recurrence

36

First line treatment for vitamin B12 deficiency anemia

cyanocobalamin PO daily

37

What is second line treatment for it b12 deficiency anemia?

cyanocobalamin IM/SC daily for 1-2 weeks
then weekly for 4 weeks
then monthly for life

38

Nasal spray treatment for vit B12 deficieny anemia

Given weekly for maintenance therapy for patients who have responded to vit B12 treatment
*must be administered 1 hour prior to ingestion of hot foods or beverages to ensure absorption
EXPENSIVE

39

3 Rare adverse effects of vit B12 therapy

– Hyperuricemia
– Hypokalemia
– Sodium retention

40

Monitoring response to treatment for vit B12 deficiency anemia?

Reticulocyte count should increase after 2-5 days
Hgb should rise in 1-2 weeks and normalize in 1-2 months
after normalization of everything recheck every 3-6 months

41

What can cause folic acid deficiency anemia?

– Increased demand
poor absorption from small intestine
ETOH
folic acid antagonist medication

42

Diagnosis of folic acid deficiant anemia

• Typical symptoms of anemia
low Hgb
increase homocysteine
low serum folic acid conc
low RBC folic acid conc

43

How do you treat folic acid deficiency anemia?

oral folic acid

44

Monitoring response to treatment of folic acid anemia?

Hgb and reticulocyte count
should normalize in 2 months

45

What is the cause of anemia of chronic disease

Cause often uncorrectable
renal disease--hemodialysis
cancer--chemo
HIV- antivirals

46

Treatment options for anemia of chronic disease?

RBC transfusions
Hgb between 8-10

47

What are side effects of blood transfusions?

– Limited resource
immunologic concerns
expensive
short term treatment
infection risk

48

Erythropoiesis stimulating agent

Drugs that mimic the bodys own erythropoiten produced by the kidneys

49

Two recombinant DNA drugs available IV/ SC in use

– Darbepoetin (Aranesp®)
– Epoetin alfa

50

Erythropoiesis are indicated for what?

– Cancer
renal disease
drug induced anemia
*given with iron supplements

51

How do ESA work?

mimic erythropoiten in the blood and circulates body until reaches bone marrow
bind to receptors on hematopoiten stem cells
stimulus results in new RBC

52

Darbepoetin (Aranesp®)

Longer half life which allows less dosing
renal dosing

53

Epoetin (Epogen®,

3 times a week
renal doses

54

Epo and Darbe dosing

Use lowest/ effective dose to achieve and maintain lowest Hgb to prevent transfusion
D/C if no response in Hgb or still require RBC transfusion after 8 weeks for epo/ 9 weeks for darbe

55

What are the max doses for EPO and Darbe?

EPO= 60,000 units per week
Darbe= 500 mcg per week

56

What are warnings seen for EPO and Darbe?

Increased mortality, Cardiovascular risk, thromboembolotic events, increased risk of tumor progression/ recurrence

57

ESA Apprise Program

FDA required this program to ensure the benefits outweigh the risks for using ESA's
prescribers and hospitals have to be enrolled in this program in order to prescribe the med

58

What are 1 thing to remember about ESA

in oncology patients ESA should only be used for treatment of anemia due to concomitant myelosuppressive chemo

59

What needs to be monitored with ESA?

• Monitor iron regularly
Hgb, HCT
BP, # blood transfusions
ESA dose

60

What is sickle cell anemia?

A group of conditions caused by genetic defects in Hgb
RBC forms sickle shape due to abnormal Hgb
hemolysis of RBC

61

What is the pathophys of sickle cell anemia?

Amino acid substitution of B polypeptide chain of Hgb
MC type= Hgb- S
requires homogenous gene for Hgb-S to cause sickle cell

62

Why do the cells sickle?

Cells impaired ability to maintain water and potassium balance
cell dehydrate causing increase in Hgb-S leading to molecular interactions that alter the form of Hgb- S
causing the sickle shape

63

Why are sickle cells bad?

blood does not flow well through capillaries
leads to impaired circulation, RBC destruction, hypoxia, and end organ damage

64

What are few early signs of acute sickle cell?

pain
swelling in hands and feet
splenomegaly

65

What are some chronic symptoms of sickle cell anemia?

– Anemia
– Fever
– Pallor
– Arthralgia
weakness
anorexia
fatigue
cardio/hepatomegaly

66

How to make a diagnosis of sickle cell anemia?

symptoms and history
• Peripheral blood smear
increase reticulocyte count, platelets
screening of newborns

67

Sickle Cell Crisis can be triggered by what?

– Infection
– Dehydration
– Hypoxia
– Acidosis
– Sudden

68

What are 4 types of sickle cell crisis?

• Vaso-occlusive crisis
aplastic crisis
hemolytic crisis
splenic sequestration

69

Vaso- occlusive crisis symptoms?

MC
cells get clogged, not allowing blood to get through
– Pain in hands, feet, jts, and, liver, lungs, extremities

70

3 goals of treatment for sickle cell anemia?

– Decrease frequency/ duration of crisis
prevent/ delay long term complications
improve QOL

71

Supportive and preventive treatment used for sickle cell anemia?

folic acid
immunizations/ vaccines
prophylactic PCN till age 5
hydroxyurea--> increase Hgb- F

72

What are some complications with treating sickle cell anemia

RBC transfusions during life threatening situations increase the risk of reaction and iron overload

73

Hematopoietic stem cell transplantation

– Only potential curative treatment
limited success
limited availability
significant risk for treatment related toxicity

74

Management of a sickle cell crisis?

IV saline 3-4L
Pain management (NSAIDs/Acetominophen for mild- mod)
opioids for mod- severe

75

What are 3 managements used in sickle cell anemia?

Treat infections
RBC transfusions
splenectomy

76

Follow up for patients with sickle cell anemia? (4)

routine CBC
monitor/ track frequency + severity of crises
monitor pain meds
counsel patients on triggers

77

Criteria of ESA for patient

anemic
chemo induced anemia/ other approved tx
cure for cancer not likely