Therapeutics of Anemia Flashcards
(81 cards)
1
Q
List the 5 signs and symptoms of anemia.
A
- exertional dyspnea
- angina
- tachycardia (compensatory)
- fatigue
- pallor
2
Q
What is the normal range of RBCs for men?
A
4.5-5.5 x 106 cells/µL
3
Q
What is the normal range of RBCs for women?
A
4.1-4.9 x 106 cells/µL
4
Q
What is the normal hemoglobin (Hgb) range for men?
A
13.5-18 g/dL
5
Q
What is the normal hemoglobin (Hgb) range for women?
A
12-16 g/dL
6
Q
What is the normal hematocrit (Hct) range for men?
A
38-50%
7
Q
What is the normal hematocrit (Hct) range for women?
A
36-46%
8
Q
What is the normal mean corpuscular volume (MCV) range for both sexes?
A
80-100 mm3
9
Q
What is the normal mean corpuscular hemoglobin (MCH) range for both sexes?
A
26-34 pg/cell
10
Q
What is the normal mean hemoglobin concentration (MCHC) range for both sexes?
A
31-37 g/dL
11
Q
What is the normal RBC distribution width (RDW) range for both sexes?
A
11.5-14.5%
12
Q
What value is the volume of RBCs per unit of blood?
A
Hematocrit (Hct)
13
Q
What value describes the average volume of RBCs?
A
mean corpuscular volume (MCV)
14
Q
What are the 3 main causes of anemia?
A
- decreased RBC production
- increased RBC destruction
- increased RBC loss
15
Q
What conditions can contribute to decreased RBC production?
A
- chronic disease (CKD, CHF)
- nutritional deficiencies (iron, folic acid, B12)
16
Q
What conditions can contribute to increased RBC destruction?
A
- drugs (i.e., hemolytic anemia)
- sickle cell anemia/thalassemia
17
Q
What conditions can contribute to increased RBC loss?
A
- acute blood loss
- chronic NSAID/ASA use
18
Q
What MCV can be considered microcytic?
A
< 80
19
Q
What MCV can be considered normocytic?
A
80-100
20
Q
What MCV can be considered macrocytic?
A
> 100
21
Q
What conditions are associated with microcytic anemia?
A
- iron deficiency
- sickle cell
- thalassemia
22
Q
What conditions are associated with normocytic anemia?
A
- anemia of chronic disease
- blood loss
- hemolysis
23
Q
What conditions are associated with macrocytic anemia?
A
- folic acid deficiency
- B12 deficiency
24
Q
What are the 6 consequences of anemia?
A
- impaired cognitive function
- increased fall risk
- heart failure worsening
- atrial fibrillation worsening
- cardiovascular events
- mortality
25
What are the 5 goals of therapy associated with anemia treatment?
1. increase Hgb
2. relieve symptoms (decrease fatigue)
3. reduce mortality (HF, cognitive impairment)
4. improve QOL
5. reduce mortality
26
What lab values can be increased in iron deficiency anemia?
* RDW (can also be neutral)
* TIBC/transferrin
27
What lab values can be decreased in iron deficiency anemia?
* Hgb
* MCV
* Ferritin
* Serum iron (can also be neutral)
* TSAT
28
What range is considered normal for ferritin?
15-200 ng/mL
29
What range is considered normal for iron?
40-160 mcg/dL
30
What range is considered normal for transferrin?
200-360 mg/dL
31
What range is considered normal for TIBC?
250-400 mcg/dL
32
What range is considered normal for TSAT?
20-50%
33
Although there is an established normal range for ferritin, iron deficiency is still likely for ferritin below what value?
\< 45 ng/mL
34
What does it mean if someone is acute phase reactant?
ferritin is elevated in acute inflammation or chronic disease
35
According to Dr. Rogers, what are the two most important values to look at in an iron study?
ferritin and TSAT
36
What are the 4 main causes of iron deficiency?
1. Blood loss (menstruation, blood donation)
2. Decreased absorption (celiac disease, gastric bypass)
3. Vegetarian diet
4. Increased consumption (like in pregnancy)
37
Where in the colon does maximal absorption occur?
duodenum
38
What are the 3 signs and symptoms of iron deficiency anemia?
1. spoon-shaped nails (koilonychias)
2. inflamed tongue (glossitis)
3. pica
39
Iron by which route is preferred when treating iron deficiency anemia?
oral
40
What are the 3 exceptions to using oral iron for iron deficiency anemia?
* can't be tolerated (side effects)
* can't be absorbed
* ESRD
41
Although oral iron dosing varies in practice, what are some of the generally accepted doses?
* 65 mg elemental iron QOD
* 120-200 mg elemental iron daily (often BID or TID)
42
What is hepcidin?
an iron-regulating peptide hormone produced in the liver
43
Hepcidin _______ dietary iron absorption and iron transfer to the plasma
decreases
44
Hepcidin is increased after a dose of oral iron for ____ hours and normalizes within ____ hours.
24; 48
45
Give the tablet strength and elemental iron in mg for ferrous fumarate.
300 mg
100 mg elemental iron (33%)
46
Give the tablet strength and elemental iron in mg for ferrous sulfate.
325 mg
65 mg elemental iron (20%)
47
Give the tablet strength and elemental iron in mg for ferrous gluconate.
300 mg
30 mg elemental iron (10%)
48
Give the tablet strength and elemental iron in mg for polysaccharide iron complex.
tablet strength varies
100% elemental iron
49
Give some counseling points for oral iron.
* increased absorption on an empty stomach
* take with food or split doses to help with stomach upset
* vitamin C (ascorbic acid) can increase absorption
* causes constipation
* causes dark stools
50
What side effects can occur with IV iron?
* hypotension during infusion (common)
* skin tattooing if it gets outside the vessel (rare)
51
What IV iron product has a risk of anaphylaxis?
iron dextran
52
What labs are increased in B12 deficiency anemia?
* MCV
* RDW
* Homocysteine/methylmalonic acid
53
What labs are neutral/unchanged in B12 deficiency anemia?
* ferritin/TIBC/transferrin
* serum iron/TSAT
54
What labs are decreased in B12 deficiency anemia?
* Hgb
* Serum B12 (\< 200)
55
List the four possible causes of B12 deficiency.
1. diet (our bodies can't make B12)
2. intrinsic factor (pernicious anemia)
3. decreased absorption (i.e., Crohn's)
4. medication (PPIs, metformin)
56
What is the recommended treatment for B12 deficiency anemia?
**VITAMIN B12 REPLACEMENT**
* 100-1000 mcg IM or deep SC injections (often daily for 1-2 weeks, then weekly-monthly as maintenance)
* 1000-2000 mcg/day PO (not as effective)
57
What labs are increased in folic acid deficiency?
* MCV
* RDW
* Homocysteine
58
What labs are neutral/unchanged in folic acid deficiency?
* ferritin/TIBC/transferrin
* serum iron/TSAT
59
What labs are decreased in folic acid deficiency?
* Hgb
* serum folate (\< 5)
60
What are some possible causes of folic acid deficiency?
* malabsorption
* malnutrition (green veggies, OJ, cereal, flour, milk have folate)
* alcoholism
* medications (MTX, phenytoin, sulfasalazine, SMX/TMP)
61
What treatment is recommended for folic acid deficiency anemia?
PO folic acid supplement 1-5 mg daily until Hgb normalizes
62
You should NEVER replace folic acid without checking \_\_\_\_\_\_.
vitamin B12
63
What kinds of conditions can cause anemia of chronic disease?
* CKD
* CHF
* Cancer
* HIV/AIDS
64
When treating anemia of CKD, why should you avoid blood transfusions in patients eligible for kidney transplant?
risk of allosensitization
65
What treatment measures are recommended for anemia of CKD?
* folate/B12/iron supplementation (PO iron in stage 3-5 if possible, IV in hemodialysis)
* ESAs (started after replenishing iron stores)
66
What is the target TSAT when treating iron deficiency in anemia of CKD?
\> 30%
67
How should ESAs be dosed for anemia of CKD?
use minimum dose to maintain Hgb \> 10, do not titrate up for at least 4 weeks after initiating/increasing dose
68
What groups of CHF patients may benefit from IV iron?
* NYHA class II/III AND
* iron deficiency (ferritin \< 100 or 100-300 if TSAT \< 20%)
69
What trial demonstrated that IV iron supplementation can lead to decreased HF hospitalizations?
AFFIRM-AHF
70
Can we use PO iron supplementation in anemia secondary to CHF?
nope, IRONOUT-HF showed no benefit
71
Why should ESAs be avoided in anemia secondary to CHF?
lack of benefit and increased risk of thromboembolic events
72
When should we consider transfusing packed RBCs (PRBCs) in blood loss anemia?
Hgb \< 7
73
How much iron is in each unit of PRBC?
250 mg
74
Give two examples of inherited hemolytic anemia.
sickle cell anemia and G6PD deficiency
75
Give an example of acquired hemolytic anemia.
drug-induced
76
In sickle cell anemia, RBCs collect in the _______ and are destroyed faster than can be produced.
spleen
77
Is sickle cell anemia dominant or recessive?
recessive
78
How should we treat sickle cell anemia?
* folic acid 1 mg/day
* hydroxyurea 10-15 mg/kg/day (titrated to max 35 mg/kg/day)
* blood transfusions PRN
* immunizations (flu, pneumococcal, meningococcal)
* pain control (APAP/NSAIDs, opioids in pain crisis)
79
Why is hydroxyurea an effective treatment for sickle cell anemia?
it is a fetal hemoglobin inducer, and helps make hemoglobin that only infants would produce (less likely to sickle)
80
Why do we need to monitor patients taking hydroxyurea?
it is an immunosuppressant
81
What type of drug-induced anemia affects patients with G6PD enzyme deficiency?
drug-induced oxidative hemolytic anemia
