Heme Geriatrics Flashcards
(50 cards)
MCC anemia worldwide
IDA
MCC IDA
chronic blood loss - in adults it’s colon CA until proven otherwise
sx IDA
pagophagia - craving for ice
PICA
koilonychia - spooning of nails
nonspecific - fatigue, weakness etc
dx IDA
CBC - decreased MCV and decreased MCHC
iron studies - decreased ferritin (< 30), decreased transferrin saturation, decreased serum iron, increased TIBC
tx IDA
iron replacement (can take with vitamin C - ascorbic acid to increase absorption) - GI ADE MC
325 mg once daily or every other day
B12 is also called
cobalamin
where do we get natural sources of B12
fish
meat
eggs
dairy products
where is B12 absorbed
distal ileum
MCC b12 deficiency
pernicious anemia - decreased intrinsic factor
other causes of B12 deficiency
Crohn dz
H2RA or PPI use
vegans
chronic alcohol use
sx B12 deficiency
similar to folate deficiency but associated with spinal cord involvement
symmetric paresthesias and numbness MC initial
gait ataxia, weakness, vibratory, sensory, and proprioception deficits
decreased DTR!!
dx B12 deficiency
CBC - increased MCV, megaloblastic anemia (macro-ovalocytes and hypersegmented neutrophils with > 5 lobes)
Decreased serum B12
Increased homocysteine
Increased methylmalonic acid (MMA)
tx B12 deficiency
sx - IM B12 weekly until corrected and then once monthly
patients with pernicious anemia need lifelong monthly IM therapy
otherwise can do oral
MC vitamin deficiency in US
folate deficiency
what is the function of folate
required for DNA synthesis; deficiency causes abnormal synthesis of DNA
how long do folate stores last
2-4 months
MCC folate deficiency
inadequate dietary intake - alcoholics, unbalanced diet, anorexia
other causes of folate deficiency
increased requirements - pregnancy, infancy, malignancy, psoriasis
impaired absorption - celiac, IBD, chronic diarrhea
meds - methotrexate, trimethoprim
dialysis
sx folate deficiency
NO NEURO ABNORMALITIES
fatigue, pallor
glossitis, aphthous ulcer, diarrhea
dx folate deficiency
CBC - increased MCV > 100, + megaloblastic anemia (hyperhsegmented neutrophils, macro-ovalocytes)
Decreased serum folate < 2
Increased homocysteine
Normal methylmalonic acid
tx folate deficiency
oral folic acid first line - 1-5 mg/day
diet rich in fruits and veggies
what is anemia of chronic disease
anemia due to decreased RBC production in the setting of chronic dz
pathophys of anemia of chronic disease
increased hepcidin - acute phase reactant that bocks the release of iron from macrophages and reduces GI absorption of iron
increased ferritin - acute phase reactant that sequesters iron into storage
dx anemia of chronic disease
CBC - normocytic normochromic anemia classic but may present with microcytic hypo chromic anemia early on
decreased reticulocytes
Iron studies - normal to increased ferritin + normal or decreased TIBC + decreased serum iron
