What are the 6 most common symptoms of anemia?
Fatigue, dizziness, pale skin, cold hands and feet, SOB, and irregular heartbeat
What is the most common nutritional deficiency of anemia?
Iron deficiency
How do we excrete iron from the body and what protein regulates absorption of iron?
The key here is we don’t have a mechanism to excrete it. Blood loss is the big key here or sloughing it off when it is in cells.
Hepcidin
Basically, what is the main problem with hypochromic microcytic anemia?
Not enough hemoglobin
3 main types of causes of microcytic anemia and give examples of each?
Reduced iron availability, so iron deficiency or inflammation
Reduced heme synthesis, sideroblastic anemia
Reduced globin production, like thalassemia
What 3 food groups do we get iron from?
Meat, fish, poultry
How do we most commonly administer iron supplement, what is the dose and how often per day, and what should patients usually take the iron with and why?
What are the 3 iron types we give and what 2 features of the iron pill do we want to avoid?
Oral
200-400 mg of 2-3 divided doses a day with water or juice. Food blocks absorption.
Ferrous sulfate, ferrous gluconate, ferrous fumarate not enteric coated and not sustained release
What if the patient can’t do oral iron, what do we do and what are the 3 options?
Parenteral iron
Iron dextran, sodium ferric gluconate complex, iron sucrose complex
4 adverse effects of iron supplementation?
Gi, heart burn, anorexia, and dark stools
Acute iron toxicity is seen almost exclusively in what patient population?
What is the problem it causes and the symptoms that follow?
2 things to treat it?
Young children who accidentally eat iron tablets.
Necrotizing gastroenteritis leading to vomiting, abdominal pain, and bloody diarhrea.
Irrigate the whole bowel and give deferoxamine which is a potent iron cheating agent
What is the problem with chronic iron toxicity?
The iron will deposit into organs like the heart, pancreas, liver and cause organ failure and death.
3 main functions of vitamin b12 he mentioned?
Metabolism, RBC formation and maintenance of CNS
If body stores of b12 are depleted, what is the rapid onset of symptoms that follow?
Neuro dysfunction
Weakness, paresis, spasticity
3 different autoantibodies in pernicious anemia?
Autoantibodies against the IF-b12 complex
Autoantibodies against IF-b12 receptors on the ileum
Autoantibodies against sodium potassium atpase pump on parietal cells
What is the b12 supplementation of choice for deficiency?
Oral b12, even in pernicious
In what setting would we use parenteral therapy of b12?
Neuro symptoms
What is the usual cause of folate deficiency?
Poor diet including alcohol
What is the treatment of choice for folate deficiency? What are the two adverse effects of high doses of folate?
Oral folate
Hypotension and hypoglycemia
What was the point of the article he mentioned about folate supplementation and its effect on b12?
In the elderly, folate can increase the risk of masking megaloblastic anemia caused by b12 deficiency
What is the effect of using Epoetin alfa and what are the three clinical scenarios you would use it in?
What is the main difference between darbepoetin and epoetin?
Increase EPO
Chronic kidney disease, cancer chemo, being treated for HIV. Chronic inflammation situations.
Darb has a longer half life.
What are the major categories of serious complications of epoetin?
MI, stroke, thrombi, etc.
What is the only approved drug for sickle cell anemia? What is the MOA for it?
Hydroxyurea
Targets ribonucleotide reductase which arrests the cell cycle in the s phase
4 side effects of hydroxyurea?
Cough/hoarseness
Fever/chills
Back pain
Hurts when you piss
What do we use eculizumab for and what is the MOA?
Paroxysmal nocturnal hemoglobinuria
Basically takes out C5 to prevent complement causing intravascular hemolysis
Big time adverse effect for using eculizumab?
Life threatening meningococcal infections so give vaccine prior to using
6 common symptoms of neutropenia?
Low grade fever, sore mouth, difficulty swallowing, gums swell, skin abscesses, and recurrent infections.
Route of administration for epoetin, hydroxyurea, and eculizumab?
IV, oral, and IV
What is considered a neutropenic fever and in what patients are these life threading?
One time temp check over 38.3 or 101 for a fever for greater than an hour
Chemo patients
What score on the MASCC risk index for febrile neutropenia is high risk?
Less than or equal to 21
