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Anemia Flashcards

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1
Q

What is haemoglobin?

A

A protein consisting of four similar polypeptide chains

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2
Q

How does the release of oxygen molecules via haemoglobin occur?

A

Each polypeptide chain has a binding site for molecular oxygen -> partial pressure of oxygen in blood and tissues -> oxygen molecules released

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3
Q

What is haemoglobin level and give the normal ranges?

A

Concentration of haemoglobin per unit volume of blood
14g/dL - 17g/dL (men)
12g/dL - 15g/dL (women)

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4
Q

What is haematocrit and give the normal ranges?

A

% of blood volume composed of erythrocytes
42%-50% (men)
37% - 46% (women)

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5
Q

What is erythropoeitin?

A

Glycosylated protein

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6
Q

Where is EPO produced in the fetus vs the adult?

A 
Fetus = liver
Adult = kidney
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7
Q

Define anemia

A

Below normal

1) plasma haemaglobin [ ] due to decreased no of circulating RBCs
2) total haemoglobin content per unit of blood volume

<13.5 (men)
<11.5 (women)

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8
Q

Name symptoms of anemia

A 
CNS
- fatigue
- dizziness
- fainting
Eyes
- yellowing
Blood vessels
- low BP
Heart
- palpitations
- rapid HR
- chest pain
- angina
- heart attack
- arrythmias
Respiratory
- SOB
Muscular
- weakness
Spleen
- enlargement
Intestinal
- changes in stool colour
Skin
- pale
- cold
- yellowing
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9
Q

Name the categories of size variations of RBCs

A 
Normal
Microcyte
Macrocyte
Oval macrocyte
Hypochromic macrocyte
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10
Q

Name the categories of haemoglobin distribution in RBCs

A

Hypochromia 1+, 2+, 3+, 4+

Polychromia

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11
Q

Name the categories of shape variations of RBCs

A 
Target cell
Sphreocyte
Ovalocyte
Stomatocyte
Sickle cell
Acanthocyte
Helmet cell
Schistocyte
Tear drop
Burr cell
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12
Q

Name the categories of inclusions of RBCs

A

Pappenheimer bodies
Cabot’s ring
Basophilic stippling
Howell-Jolly

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13
Q

Name the categories of red cell distribution of RBCs

A

Agglutination

Rouleaux

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14
Q

Classify anemia by morphology

A
  1. MCV >98
    = Macrocytic
    - megaloblastic
    - non-megaloblastic
  2. Normal MCV
    = Normocytic
  3. MCV <78 / MCH <26
    = Microcytic
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15
Q

Name the most common causes of blood loss

A

Menstruation
Drug treatment eg NSAIDs
Pathology eg colon carcinoma
Parasitic infection

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16
Q

Name causes of bone marrow depression

A 
Drug toxicity (anticancer, clozapine)
Radiation exposure
BM diseases (idiopathic aplastic anemia, leukemia)
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17
Q

Which nutrients are necessary for haemopoeisis?

A 
Iron
Folic acid
Vitamin B12
Pyridoxine
Vitamin C
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18
Q

Name causes of decr production/response to EPO

A

Chronic renal failure
Rheumatoid arthritis
AIDS

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19
Q

Name causes of microcytic anemia

A

Iron deficiency
Thalassemia minor
Sideroblastic anemia
Long standing anemia of chronic disease

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20
Q

Name causes of megaloblastic anemia

A

Vitamin B12 deficiency

Folate deficiency

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21
Q

Name causes of non-megaloblastic anemia

A 
Alcohol
Liver cirrhosis
Reticulocytosis
Hypothyroidism
Marrow infiltration
Myelodysplastic syndrome
Myoproliferative disease
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22
Q

Name causes of vitamin B12 deficiency

A 
Pernicious anemia (lack of IF)
Tropical sprue/bacterial overgrowth
Ileal disease (Chron's)
Fish tapeworm
Diet (vegan)
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23
Q

Name causes of folate deficiency

A 
Diet (alcoholics)
Malabsorption (Coeliac's)
Incr cell turnover 
- pregnancy
- leukemia
- chronic haemolysis
- chronic inflammation
Anti-folate drugs
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24
Q

Name anti-folate drugs

A

Phenytoin

Methotrexate

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25
Name causes of normocytic aenemia
``` Bone marrow failure - aplastic anemia - ineffective erythropoesis - infiltration Anemia of chronic disease Haemolytic anemia - intracorpuscular - extracorpuscular ```
26
Name causes of aplastic anemia
``` Drugs (phenytoin, indomethacin, sulfonamides) Radiation SLE Viral hepatitis Pregnancy Fanconi's syndrome ```
27
Name causes of ineffective erythropoesis
Myelodysplastic syndrome | Paroxysmal nocturnal hemoglobinuria
28
Name causes of anemia of chronic disease
``` Chronic inflammation (abscess, TB, CT disease) Malignancy Endocrine (hypothy, hypopit, Addison's) Liver disease CKD Malnutrition ```
29
Name causes of intracorpuscular haemolytic anemia
``` Hereditary spherocytosis Hereditary elliptocytosis Haemoglobinopathies - thalassemia - PNH - sickle cell disease ```
30
Name causes of extracorpuscular haemolytic anemia
``` Autoimmune Incompatible blood transfusion Hypersplenism Trauma (prosthetic heart valves, marathon runner) Microangiopathys (DIC) Toxic (malaria) ```
31
Name causes of bone marrow failure due to infiltration
``` Leukemia Lymphoma Myeloma Granuloma Myelofibrosis ```
32
Name signs of anemia
``` Pallor Tachycardia Wide pulse pressure Systolic ejection murmurs - rise in CO and HR ```
33
How can you treat anemia?
Dependent on the cause
34
Name the adverse effects of cyanocobalamin
``` Injection site pain Arthralgia Dizziness Headache Nasopharyngitis Anaphylaxis ```
35
Name potential drug interactions with cyanobalamin
PPIs decrease B12 oral absorption
36
Name the adverse effects of erythropoietin/epoetin alfa
``` Oedema Pruritis N+V Hyperension CVA Thrombosis ```
37
Name potential drug interactions with erythropoietin/epoetin alfa
Darbepoeitin alfa -> incr adverse events
38
Name the adverse effects of darbepoetin alfa
``` Oedema Dyspnoea Hypertension CVA Thrombosis ```
39
Name potential drug interactions with darbapoetin alfa
Epoetin alfa => adverse events
40
Name the adverse effects of folic acid
Bad taste in mouth Nausea Confusion Irratibility
41
Name potential drug interactions with folic acid
Cholestyramine can interfere with its absorption
42
Name the adverse effects of iron
``` Pruritis NVD Constipation Headache Anaphylaxis ```
43
Name potential drug interactions with iron
Deferoxamine/dimercaprol | Chelate iron
44
Name treatment options for sickle cell anemia
Hydroxyurea | Pentoxifylline
45
Name the adverse effects of hydroxyurea
Myelosuppresion Skin ulcers Secondary leukemia
46
Name potential drug interactions with hydroxyurea
``` HIV medications - decr CD4 count Salicylates - incr bleeding risk Probenecid - incr uric acid ```
47
Name the adverse effects of pentoxifylline
NV Thrombocytopenia Jaundice Anaphylaxis
48
Name potential drug interactions with pentoxifylline
Ketorolac - incr bleeding risk Gingko biloba - incr antiplatelet effect
49
Name the available iron formulations
``` Ferrous gluconate Ferric ammonium citrate Ferrous sulfate Anhydrous ferrous sulfate Ferrous fumarate Carbonyl iron Polysaccharide-iron complex ```
50
Give the brand name(s) of ferrous gluconate
Fergon
51
Give the brand name(s) of ferric ammonium citrate
Iron citrate
52
Give the brand name(s) of ferrous sulfate
Fer-in-sol | Feosol
53
Give the brand name(s) of ferrous fumarate
Slow-FE
54
Give the brand name(s) of carbonyl iron
Ferretts Ferrimin Hemocyte
55
Give the brand name(s) of polysaccharide-iron complex
Nu-iron 150 | Niferex
56
Discuss the use of ferrous gluconate
12% elemental iron | Less elemental iron that FS but similar tolerability
57
Discuss the use of ferric ammonium citrate
18% elemental iron Less bioavailable than ferrous salts Intestine needs to reduce it to ferrous form
58
Discuss the use of ferrous sulfate
``` 20% elemental iron Most common supplement Low cost Good effectiveness Good tolerability ```
59
Discuss the use of anhydrous ferrous sulfate
30% elemental iron Extended release formulation Higher cost
60
Discuss the use of ferrous fumarate
33% elemental iron Similar effectiveness + tolerability to FS Almost no taste vs other iron salts
61
Discuss the use of carbonyl iron
100% elemental iron Microparticles of purified iron Dissolves in stomach to form HCl salt -> absorbed Less toxic than iron salts due to slower absorption rate
62
Discuss the use of polysaccharide-iron complex
100% elemental iron Tasteless Odourless Similar bioavailability to FS
63
How can you administer erythropoietin?
IV Subcutaneously Intraperitoneally
64
Name adverse effects of EPO
Transient flu-like symptoms Hypertension Iron deficiency Incr blood viscosity
65
Which drug exacerbates the anemia of AIDS?
Zidovudine

Pharmacology (32 decks)

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