IC3+7 Anemia Flashcards
(39 cards)
3 broad classification of anemia
- Hypoproliferative
- marrow damage
- dcr stimulation (e.g., due to renal disease, inflammation, metabolic disease)
- iron deficiency
- Maturation disorder
Cytoplasmic defects
- iron deficiency
- thalassemia
- sideroblastic
Nuclear maturation defect
- folate deficiency
- vit B12 deficiency
- Hemolysis/hemorrhage
What is the Hb cut off for females and males respectively?
Females <11.9
Males <12.9
Top 4 most common causes of anemia
- iron deficiency
- vit b12/folic acid deficiency
- anemia of inflammation/chronic disease
- drug-induced anemia
History taking for pt with suspected anemia
- recent blood loss
- duration of anemia (genetic or acquired)
- S&S - exertional symptoms due to reduced O2 carrying capacity?
- Comorbidities - could it be anemia of chronic diseases?
Physical examination of pt with suspected anemia
- Pallor (nail bed, eyelid, tongue)
- Jaundice (hemolytic anemia)
- Bruising/bleeding (petechiae, ecchymoses)
- Lymphadenopathy, hepatosplenomegaly, bone tenderness
Symptoms of anemia (acute vs chronic)
Acute: lightheadedness, tachycardia, dyspnea
Chronic: weakness, fatigue, headache, vertigo, pallor
Laboratory evaluation for pt with suspected anemia
- FBC - Hb (F <11.9; M<12.9)
- Reticulocyte count - incr count suggest body trying to produce more RBCs (note that if R count is low, it could suggests bone marrow failure)
- Peripheral smear - observe micro/macrocytic, hypochromic etc.
Anemia diagnosis:
- Iron deficiency anemia
Microcytic
Hypochromic
Low serum ferritin, decreased transferrin saturation
*Very few small Hb-poor erythrocytes
*Iron deficiency inhibits hemoglobin synthesis
Anemia diagnosis:
- Folic acid/Vit B12 deficiency
Macrocytic, hyperchromic
*Very few large, Hb-rich erythrocytes
*Folic acid/Vit B12 deficiency inhibits DNA synthesis - cell multiplication
Anemia diagnosis:
- Acute blood loss/Hemolysis
Normocytic (normal MCV)
High reticulocyte count
Anemia diagnosis:
- Anemia of chronic disease (e.g., CKD, RA, IBD)
Microcytic
Normal/high ferritin
Low TIBC (total iron binding capacity)
Serum iron decreased
*Due to release of chemical hepcidin in chronic inflammatory states => regulates iron
Anemia diagnosis:
- pt has microcytic, normal/high ferritin, normal/high TIBC
Lead intoxication
Thalassemia (insufficient Hb)
Sideroblastic (lack of RBC, too much iron)
Anemia diagnosis:
- Drug-induced anemia
Macrocytic
[Iron deficiency anemia]
Causes of iron deficiency anemia
Either blood/iron loss or reduced iron absorption
*Blood loss more common
[Iron deficiency anemia]
What might cause reduced iron absorption
- Gastric bypass
- PPIs (incr pH causes reduced iron absorption)
- Gastritis
- Celiac disease
[Iron deficiency anemia]
Treatment of IDA
1000-1500mg elemental iron for complete supplementation, at least 3-6 months
Daily dose: 30-40mg to 200mg of elemental iron, divided into 2-3 doses
For patients with IDA, the generally recommended dose is about 150 to 200 mg of elemental iron daily, usually in two or three divided doses to maximize tolerability. If patients cannot tolerate this daily dose of elemental iron, smaller amounts of elemental iron (eg, single 325mg tablet of Fe2+ sulfate) usually are sufficient to replace iron stores, although at a slower rate.
[Iron deficiency anemia]
Which iron formulation contains 100% elemental iron
Iron polymaltose
[Iron deficiency anemia] - IC3
What other oral or parenteral formulations are there?
Oral - ferrous sulphate
IV - iron sucrose
[Iron deficiency anemia]
Side effects of iron supplementation
- Constipation
- GI complaints: metallic taste, nausea, flatulence, constipation, diarrhea, epigastric distress, vomiting
[Iron deficiency anemia] - IC3
Overdose can lead to toxicity as there is minimal elimination of iron in the feces, bile, urine, and sweat
What are the acute and chronic toxicities that may result?
Acute:
- Necrotizing gastroenteritis with vomiting, abdominal pain
- Bloody diarrhea followed by shock, lethargy, dyspnea, metabolic acidosis, coma and death
Chronic:
- Hemochromatosis - iron deposit in heart, liver, pancreas, other organs => resulting in organ failure and death
[Iron deficiency anemia] - IC3
Treatment of iron overdose
Iron chelators:
- Parenteral deferoxamine
- Oral deferasirox
[Anemia of inflammation]
List some conditions a/w anemia of chronic diseases
- Malignancy
- HIV infection
- Rheumatologic disorders
- Inflammatory bowel disease
- Castleman disease
- Heart failure
- Renal insufficiency
- COPD
[Vit B12 deficiency]
Vit B12 is almost exclusively found in ____
Meats
*Not found in vegetables
[Vit B12 deficiency]
Common causes
- Reduced absorption (due to lack of intrinsic factor or gastric disruption)
- Nutritional (lack of Vit B12 intake from diet)
- PPIs, H2RAs may increase gastric pH, reduce absorption
- H. pylori infection may disrupt gatric mucosa, reduce absorption
- Metformin increases the risk of Vit b12 malformation
