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anemia 439B Flashcards

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1
Q

regular Hgb levels

A

hbg <11 non prego females

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2
Q

MCV

A

mean corpuscular volume

mcv100

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3
Q

INTIAL lab approach

A
  • is patient bld now or in the past? old cbc… anisocytosis or pokilocytosis or wbc ab
  • is there evidence for increased RBC
  • bone marrow suppressed?
  • iorn deficient- yes? why?
  • deficient in Folic acid or Vit b12- why?
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4
Q

reasons for microcytic anemia

A 
MCV <80
iron def
thalessemia
anemia of chronic disease
siderblastic anemia
lead poisoning
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5
Q

reasons for normocytic anemia

A 
mcv 80-99
 sickle cell disease
aplastic anemia
anemia of chronic disease
hemolytic anemias
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6
Q

reasons for macrocytic anemia

A

mcv >100
vit b12 def
folate def

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7
Q

IDA- s&s

A

asymptomatic usually
s&S- fatigue, decreased exercise tolerance, weakness, palpitations, irritability, HA
conjunctival pallor, angular cheilitis, decreased tongue papillae, pallor of palms and hands, koilonychia (lines in nails)

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8
Q

etiologies of IDA

A 
abnormal uterine bld
LT use of NSAIDS
colon CA
GI issue- PUD, h plyoria, gastrectomy etc.
other- hematuria /epistaxis
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9
Q

Reticulocyte count

A

determine RBC underproduction from hemolysis
- high- bone marrow responding normally to bld loss, hemolysis or replacement of iron
norm 0.5-1.5%
with iron therapy 7-10 days increase and MCV normalize

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10
Q

IDA indicator

A

low ferritin level earliest indicator

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11
Q

Anemia of chronic disease

A 
serum iron low (iron not released from storage)
Transferrin TIBC low or normal
Transferrin Sat low
Ferritin high or normal
inflammatory markers- very high!
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12
Q

IDA levels

A 
serum iron- low
TIBC- very high  (iron stores depleted, empty binding sites)
Transferrin sat- low
Ferritin- low (depleted iron stores)
Inflammatory markers- normal
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13
Q

both acute and IDA anemia

A 
serum iron- low
TIBC- low
transferrin sat- low
Ferritin- normal or slighly low
Inflammatory markers- very high
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14
Q

ferritin

A

iron stores

low- depleted stores

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15
Q

TIBC

A

capacity is how many of those receptors available with binding
insuf iron- more space available

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16
Q

special characteristics of cells

A

spur cells, burr cells, schistocytes, spherocytes, target cells, teardrop cells, basophilic stippling
- more than iron def if these are reported in RBC

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17
Q

Iron Therapy considerations PO

A

NOT with food
2 hours before 4 hrs after ingestion of antacids
elemental iron 150-200mg daily
best absorbed with mildly acidic so add ascorbic acid tablet (250mg) or half glass or OJ to enhance

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18
Q

foods to avoid with iron supp

A

phosphates, phyates, and tannates in food
bind with iron and impair absorption
ca foods, tea, coffee, milk, eggs, fiber cereals

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19
Q

meds to avoid with iron supp

A

antacids, h2b, ppi, ca supp, abx (quinolones and tetracyclines)
iron fortified cereals, fiber, tea, coffee

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20
Q

ferrous fumarate

A

324 mg total
106mg element
bid daily

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21
Q

ferrous gluconate

Study These Flashcards
A

300mg total
38 mg element
1-3 tabs TID daily

22
Q

ferrous sulfate

Study These Flashcards
A

325mg total
65mg element
1 tab TID

23
Q

geri ferrous sulfate elixir

Study These Flashcards
A

44mg elemental per 5cc

24
Q

SE of iron supp

Study These Flashcards
A

N/V/D, constipation epigastric distresss
- try smaller dose of elemental irion (sulfate to gluconate) or tab to liquid prep
only increase slowly
if must - take with food but decrease abp by 40%

25
Expected response to Iron suppl
* Immediate disappearance of PICA or RLS * Improved feeling of well being within first few days of treatment * For mod-severe anemia: modest reticulocytosis will be seen in 7-10 days (those w mild have no reticulocytosis). * Hgb will rise slowly after approx. 1-2 weeks and will rise 2g/dL over approx. 3 weeks. * Hgb deficit should be halved by approx. 1 month and hgb level should return to normal by 6-8 weeks.
26
Failure to respond to PO therapy
1) co-exisiting diseases 2) IDA incorrect dx- thalessemia, lead posiiong, etc) 3) non-adherence 4) not absorbed- malapsorbtion of iron 5) continued blood loss or need in excess iron dose being ingested (PUD) - tx underlying problem
27
H.Pylori causes IDA
- increased iron loss d/t active hemorrhage secondary gastrtitis, PUD, CA - achlorhydria induced by chronic gastritis resulting ( reduced iron absorption) - reduced secretion of ascorbic acid to gastric muscosa - iron utilization by bacterium (using for their own work)
28
common causes of normocytic anemia
- increased RBC loss i.e. acute bleed, hemolysis - decreased production of normal sized RBCs i.e. aplastic anemai, chronic disease anemai, endocrine DO - overexpansion of plasma volume i. e. prego or fld overload
29
Macrocytic anemias
slide
30
anemia of chronic disease/inflammation patho
infection, chronic inflam macrophages stim and activate cytokine release i.e. IL-6, induces hepcidin which inhibits iron release- protective measurement
31
anemia of chronic disease tx
- tx underlying condition- infection/inflam | check ESR/c-reactive protien
32
sickle cell
normochromic but not normocytic- decreased rbc loss
33
vitamin b12 needed
DNA synthesis formation of myelin sheaths- neuro deficits synthesis of neurotransmitters - depression with vit b12 def. erythropoiesis
34
PE of vit b12 def
- numbness/paresthesisas - cognitive impairment and depression - symmetrically decreased vibration and proprioception in feet. - absent or decreased DTR in LE
35
cobalamin
vit b12 | a water soluble vitamin req for proper RBC function, neuro function and DNA synthesis
36
late biomarker of vit b12
serum vit b12- low sen/spe when used alone
37
earliest bio marker of vit b12
holotranscobalamin aka active b12 | elevated homocysteine >13 and elevated MMA (>0.4) are seen in vit b12
38
MMA
methylamolonic acid >0.4 | most specific for vit b12
39
Vitamin B12 Deficiency lab Levels look..
``` MCV >100 macrocytosis with hypersegmented pernicious anemia - poss homocystine- elevated MMA- elevated ```
40
Folate Def lab levels....
``` >100 MCV macrocytosis with hypersegmented neutrophils per anemia- NO homocystine- elevated MMA- NORMAL** ```
41
risk factors Vit b12
``` decreased ileal absorption decreased intrinsic factor genetic inadq intake prolonged med use (h2b, metformin, PPI) food/vit b12 malabsorption ```
42
best dietary food for Vitamin B 12
fortified breakfast cereals
43
tx vit b12 def
1000ug daily x1 week then weekly x 1month then monthly for life- unless underlying cause tx - 1000-2000 mcg of crystalline cobalamin PO daily
44
Folate normal level
>4ng/ml
45
folate def dx level
<2ng/ml as long as anorexia or fasting
46
tx folate def by...
prevent neural tube deficits 1mg PO daily r/o vit b12 before folic aacid begins- dont want to mask symptoms of vit b12 def
47
older adults vit b12 reason 1
low or normal b12 and elevated metabolites due to age (decrease gastric acid) and atrophic gastritits (food bound malabsorption) ** inabiliyt to release b12 from food or binding protein
48
older adults vit b12 reason 2
small intestinal bacterial overgrowth from decreased gastric acid and reduced intestinal motility h.plylori most common
49
vitamin b12 reason 3
- PPI H2B exacerbating impairment of b12 absorption from food
50
vitamin b12 reason 4
nitrous oxide induce def by oxidizing and sub inactivating b12
51
meds that inhibit vit b12 absorption
``` pPI H2B metformin colchine abx anti-convulsants ```
52
dietary intake of vit b12
2.4 ug per day | body store- 2-5mg in liver

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