What are the three indications that would diagnose a person with anemia?
Decreased number of RBC
Decrease in size of RBC
Decrease in content of RBC
What test determine anemia?
Hemoglobin
What is the normal Hgb for males?
12-15 gm/dL
What is the normal Hgb for females?
14-17 gm/dL
What are the 4 ingredients that make up RBC?
Iron
Vit. B-12
Folic Acid
Erythropoetin
What is the most common nutritional deficiency?
Iron (5% of population)
How much iron do women need?
15-18 mg/dL
How much iron do men need?
8 mg/dL
How much iron do infants need?
11 mg/dL
What are some food sources of iron?
Egg yolks, muscle meats, beans, green leafy vegetables
Does milk have iron?
No
*“milk babies”
What is the name of iron given PO?
Ferrous sulfate
What is the name of iron given IV?
Iron dextran
Do we give iron IM?
You can, but it is rarely done
What are the adverse effects of iron?
GI issues (nausea)
Dark/green black stool
Liquid ferrous sulfate can stain teeth
If your patient is taking iron and they have dark/green black stool does that mean they are experiencing a sign and symptom of a GI bleed?
No; while melena is a S&S of a GI bleed (as in the case of warfarin), if a patient it taking iron this is a HARMLESS adverse effect
How should we administer iron?
On an empty stomach because food with decrease the absorption of iron by 50-70%
So iron causes GI issues (nausea). Pregnant women need lots of iron. They may already experience morning sickness. Is it okay if we tell them to take iron with food?
The best option would be to decrease the dosage of iron to a tolerable rate before you say they can take it with food
What is the max dose of iron a day?
200 mg/d
What are some meds that inhibit the absorption of iron?
Antacids (decreases iron absorption only)
Tetracyclines (decreases iron absorption and the tetracycline absorption)
What does Vitamin C do to the absorption of iron?
Increases iron absorption
Vitamin C increases iron absorption, but we tell patients not to take their iron with vitamin C. Why do we tell them that?
While Vit. C may increase the absorption of iron, it also increases the adverse effects! There is NO advantage to this. Don’t take vitamin C to increase absorption, simply, increase the iron dosage.
Why do people have deficiency in vitamin B-12?
Impaired absorption
What is pernicious anemia?
It is when the stomach has no intrinsic factor so B12 is not absorbed, the patient becomes anemic and can develop brain damage and die.
This can be treated!!
What is the name of the version of B12 we give?
Cyanocobalamin
How can we administer cyanocobalamin?
PO, intranasal, IM, or SQ
What are the adverse effects of cyanocobalamin?
It is pretty well tolerated
HYPOkalemia is an adverse effect but it is rare
Why do people have folic acid deficiencies?
Poor diets (alcoholics) and malabsorption (example of the GI disorder sprue)
What are the consequences of taking folic acid?
Same as vitamin B12 minus the neurological damage that can occur with B12 and pernicious anemia
How can we administer folic acid?
PO, IM, IV, SQ
Is it normal to give an injection of folic acid?
No; injections are ONLY given to those with SEVERE absorption issues
What are the short term adverse effects of folic acid?
There are none
What are the long term adverse effects of folic acid?
Cancer
What happens with EPO if a patient has chronic kidney disease?
Diseased kidneys don’t make EPO like they are supposed to. EPO normally go to red bone marrow when there are not enough RBC so that the bone marrow will stimulate the production of them. Patients with chronic kidney disease don’t make EPO like they are supposed to and don’t go to the red bone marrow so the red bone marrow can’t stimulate the production of RBC
What are the two EPO meds?
Epoetin alfa
Darbepoetin alfa
What is the therapeutic goal for epoetin alfa?
Decrease the need for transfusion
What kind of patients take EPO drugs?
Anemia due to chronic renal failure
Chemo induced anemia
HIV infected patients taking zidovudine (AZT)
What are the 3 adverse effects of taking EPO?
Hypertension
Cardiovascular effects
Cancer patients can have tumor progression
What is the most common adverse effect of taking an EPO?
Hypertension
Can you take an EPO if you have uncontrolled hypertension?
No
30% of dialysis patients have to ____ the BP medication when starting EPO. Why?
Increase; EPO can cause hypertension
Another adverse effect of EPO is cardiovascular effects? What does this mean?
EPO can increase the risks of MI, HF, stroke, etc
What can EPOs do to tumors?
Stimulate the tumors to grow
T/F. In patients taking EPOs, we want the Hgb to increase quickly.
FALSE!! That is dangerous!
Since we don’t want Hgb to increase quickly in patients taking EPO, in a 2 week period, Hgb should NOT rise by more than __.
1 gm/dL
T/F. EPO should only be taken if they are really needed. Once Hgb gets to normal ranges, we stop taking the medication.
False. Medication is stopped when the Hgb is at “NEAR” normal
What is the level in which you stop the Hgb drug?
Hgb greater than 11
T/F. Before administering an EPO we need to shake the bottle.
FALSE. EPO=a protein! The protein in the drug will break if you shake it
How do we store EPO?
In the fridge. DO NOT FREEZE
