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Therapeutics III > Anemia - Block 4 > Flashcards

Anemia - Block 4 Flashcards

1
Q

WHat is anemia?

A

Decrease in RBC, RBC mass, and Hgb concentration

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2
Q

What values constitutes anemia?

A

Males: Hgb <13 g/L
Non pregnanct women: Hgb <12 g/L

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3
Q

What is the life span of RBC?

A

120 days

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4
Q

What is is the function of EPO?

A

Initiates and stimulates the production of RBCs
* prevent apoptosis -> proliferation and maturation

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5
Q

Describe the structure of Hgb?

A
  1. 2 a chains and 2 b-chains
  2. Chelated iron
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6
Q

What is transferrin?

A

Transport protein that delivers iron to bone marrow so it can be incorporated into Hgb

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7
Q

Where are old blood cells destroyed/broken down?

A

Spleen and narrow

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8
Q

What are the presnetations of anemia?

A
  1. SOB
  2. Fatigue
  3. Irritability
  4. DZ
  5. Weakness
  6. Tachycardia
  7. Vertigo
  8. HA
  9. Chest pain
  10. Ecchymoses
  11. Blood in sttol or urine
  12. Hematomas
  13. Neurologic
  14. Pale
  15. ALtered mental status
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9
Q

What type of anemia causes neurologic manifestations?

A

Vitamin B12 def

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10
Q

What is in a fishbone?

A
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11
Q

What are the elements of a CBC diagram?

A
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12
Q

What is the normal Hgb value?

A

Male: 14-17
Female: 12-16

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13
Q

What is normal MCV value?

A

80-100 fL

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14
Q

What are the functional defects of anemia?

A
  1. Hypoproliferative: marrow damage, iron def, decreases RBC stimulation
  2. Maturation dx: Iron, folate, vit b12 deficiency
  3. Hemorrhage/hemolysis: blood loss, autoimmune, hemolysis
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15
Q

Describe the types of anemia?

A
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16
Q

What are the labs associated with microcytic anemia?

A
  1. Serum iron
  2. Total iron binding capacity
  3. percentage transferrin saturation
  4. Serum ferritin
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17
Q

What are the labs associated with macrocytic anemia?

A

Folic acid and VIt B12

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18
Q

How should we diagnose anemia?

A
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19
Q

What is the most common type of deficinecy?

A

Iron

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20
Q

What is hepcidin?

A

Regulator of absorption, iron recycling, and iron mobilization from hepatic stores

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21
Q

What type of iron is best absorbed? What type of iron is in most Western diets?

A

Ferrous (Fe2+)

Ferric (Fe3+)

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22
Q

What is the daily iron recommendations?

A

Male and postmeno females: 8 mg
Menstruating females: 18 mg

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23
Q

What are the manifestations of ID?

A
  1. Iron stores reduced without reduced serum levels
  2. Iron stores depleted, but Hgb remains within normal ranges
  3. Hgb falls -> anemia
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24
Q

What is your earliest and most sensitive laboratory change in an iron panel?

A

Ferritn

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24
Q

What are the s/s for IDA?

A
  1. Alopecia
  2. Dry/damaged hair and skin
  3. Atrophic glossitis
  4. RLS
  5. Cold intolerance
  6. Pica
  7. Brittle nails
  8. Irritability
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25
Q

What are the components of an iron panel and how is that affected by IDA?

A

Total iron binding capacity (TIBC): elevated
Serum iron: decreased
Ferritin: decreased
Transferrin saturation: decreased

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26
Q

Why would TIBC be elevated in IDA?

A

Cells have a lot of capacity to bind to iron

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27
Q

What is the tx for IDA?

A

PO iron supplementation
Dosing:
* Adults: 100-200 mg elemental iron/day divided into 2-3 doses
* Children: 3-6 mg/kg/d in 3 doses

28
Q

How long is PO iron tx duration?

A

continue treatment for 3-6 months after anemia resolved to replete stores & prevent relapse

29
Q

What is your most prescribed iron product?

A

Ferrous sulfate

30
Q

Describe the absorption of iron?

A
  1. Food decreases absorption as much as 50%, however does mitigate Gi upset
  2. Ferrous iron (Fe2+) > ferric (Fe3+)
    * Polysaccaride iron complex -> ferric form that has less GI irritation
31
Q

How much should Hgb levels increase when using iron?

A

1 g/dL Q2-3W

32
Q

What are the ADRs of iron?

A

Constipation, dark/tarry stools

  • Iron toxicity is reversed by deferoxamine
33
Q

What is the difference between GI bleed and iron stool?

A

GI bleed: loose
Iron: hard and solid

34
Q

When would parenteral iron be used?

A
  1. Failure and intolerance to PO
  2. Quick recovery
  3. COnjunction with ESA
  4. Anemia of CKD/other states unresponsive to ESAs alone
  5. Substitute for blood transfusions
35
Q

How is parenteral iron dosed? ADR?

A

Weight based

N/V, hypersentitivity, life threatening -> slow infusion rate

36
Q

What iron formulation requires a test dose before admin?

A

Iron dextran

37
Q

When do you see improvement in IBD with PO iron?

A
  1. reticulocytosis in days
  2. increase in Hgb after ~ 2 wks
  3. normal levels of iron reached by 2 months

serum ferritin concentrations should return to normal (~6-12 months)

38
Q

When does acute iron tox occur?

A

1-6 hr after ingestion

39
Q

What is the tx for acute iron tox?

A
  1. Supportive therapy
  2. Iron chelation w/ deferoxamine
40
Q

Who are more prone to chronic iron tx?

A

Chemo
Prolonged iron exposure

41
Q

Tx for iron overload (chronic iron tox)?

A

Deferoxamine IM, IV, SC
Transferrin infusions

42
Q

What are the tx options of anemia in CKD?

A
  1. iron
  2. ESA
43
Q

When should iron be initiated in CKD patients?

A

KDIGO: TSAT ≤ 30% & ferritin ≤ 500 ng/mL
HD: IV iron
Non-HD: PO iron

  • ESA is ineffective when iron stores are low

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44
Q

When should ESA be initiated in CKD patients?

A

Initiation:
* Individualize for Non-HD pts w/ Hgb < 10 g/dL
* CKD 5D initiate ESA at Hgb between 9-10 g/dL; avoid Hgb <9 g/dL

Maintenacne:
* do not use to maintain Hgb > 11.5 g/dL -> thrombosis
* Do not exceed Hgb > 13 g/dL

45
Q

What are the types of ESA?

A

Epoetin alfa
Darbepoetin

46
Q

What is our Hgb target for ESA?

A

11-12 g/dL

No response after 8 weeks: DC
Montior Hgb twice weekly -> 2-6 weeks for dosage adjustment

47
Q

What are causes of anemia due to inflammation?

A
  1. Chronic infection
  2. Chronic inflammation
  3. Malignancies
  4. Less common causes
48
Q

What is the difference between ACD and ACI?

A

ACD: develops over months to yrs -> reflects severity of dx

ACI: develops over days, typically in the hospital

49
Q

What are the factors that contribute to anemia inflammation?

A
  1. BLunted EPO response to anemia
  2. Disturbance of iron homeostasis
  3. Impaired proliferation of erythroid progenitor cells
50
Q

Describe the labs of AI?

A

Ferritin and hepcidin increase
TIBC decrease

51
Q

What is the tx for AI?

A

Iron
ESA: if patient is noncurative with non-myeloid tumors
RBC transfusion: if patient is curative

52
Q

What are the labs of hemolytic anemia?

A
  1. Decreased Hgb/Hct and haptoglobin
  2. Reticulocytosis
  3. Abnormal peripheral blood smear
  4. Increased unconjugated bilirubin and lactate dehydrogenase
53
Q

What is the tx for hemolytic anemia?

A
  1. Removal of offending drug
  2. Tx of underlying dx
  3. Transfusion as necessary
54
Q

What are the causes of megaloblasic anemia?

A
  1. Vit B12 def
  2. FOlate
  3. Drug induced

Abnormal DNA metabolism -> large, immature RBCs

55
Q

What are the causes of vit b12 def?

A
  1. Inadequate intake (alcoholics)
  2. Malabsorption
  3. Inadequate utilization
56
Q

What is the recommended dietary allowanceof b12?

A

Adults: 2.4 mcg/d
Pregnant and breast-feeding women: 2.6 mcg/d

57
Q

Common problem with B12 def?

A

Neurologic complications

58
Q

Sources of B12?

A
  1. Fish
  2. Fortified cereals
  3. Liver
59
Q

Labs of macrocytic anemia from B12 def?

A
  1. MSV (elevated)
  2. Low B12 and folate
60
Q

What is the tx for macrocytic anemia?

A

Cyanocobalmin

61
Q

How do we evalute B12 therapy?

A

Reticulocytosis: 3-5 days
Hgb: rise in first week and normalize in 1-2 months
Maintence: 3-6 months after initation

62
Q

What is the recommneded amount of folate?

A

Adults: 400 mcg/day
Pregnant females: 600 mcg/day
Lactating females: 500 mcg/day

63
Q

What is the lab findings of macrocytic anemia from folate def?

A
  1. MCV (elevated)
  2. Homocystein (elevated)
  3. Serum folate (decreased)
64
Q

What is the tx for folate def anemia?

A
  1. Correct B12 first with cyanocobalmin
  2. Folic acid supplementation for 4 months
  3. CHeck for ADRs: site pain, flushing, malaise
65
Q

How should we evaluate folic acid therapy?

A
  1. Reticulocytosis in first week
  2. Hgb/Hct begins to rise within 2 weeks reaches normal levels within ~ 2 months
  3. Increased alertness and appetite often occur early in treatment
66
Q

What are drugs that cause B12 def?

A

Alcohol, metformin, PPI, H2RA

67
Q

What is nonmegaloblastic anemia?

A

No impariment of DNA synthesis, normal B12 and folate

68
Q
A

Therapeutics III (40 decks)

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