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63 Cards in this Set
- Front
- Back
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What is anemia?
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disease characterized by a decrease in Hb or RBCs, resulting in decreased oxygen carrying capacity of blood
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What is macrocytic anemia?
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RBCs larger than normal, vitamin B12 anemia or folate deficiency anemia
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What is microcytic anemia?
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cells are smaller than normal, iron deficiency anemia
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What is normocytic anemia?
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cells are normal size, associated with blood loss or chronic disease
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What can cause iron deficiency anemia?
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inadequate dietary intake, inadequate GI absorption, increased iron demand (pregnancy), blood loss, chronic disease
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What can cause vitamin B12 anemia?
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inadequate dietary intake, decreased absorption (deficiency of intrinsic factor), inadequate utilization,
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What is pernicious anemia?
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deficiency of intrinsic factor
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What can cause folate deficiency anemia?
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inadequate dietary intake, decreased absorption, inadequate utilization, hyperutilization due to pregnancy, hemolytic anemia, myelofibrosis, malignancy, chronic inflammatory disorder, long term dialysis, growth spurt
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How does phenytoin cause anemia?
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reducing absorption of folate
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What does MTX cause anemia?
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interfering with corresponding metabolic pathways
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What is anemia of chronic disease?
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hypoproliferative anemia associated with chronic infectious or inflammatory processes, tissue injury, or condition that release proinflammatory cytokines
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What causes anemia of chronic disease?
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shortened RBC survival, impaired marrow response, disturbance of iron metabolism
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What causes anemmia of critical illness?
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RBC replenishment and homeostasis altered by blood loss or cytokines, which blunts erythropoietic response and inhibits RBC production
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Are elderly more susceptible to anemia?
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yes, reduction in bone marrow
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What causes anemia in children?
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primary hematologic abnormality
rapid growth spurts and dietary deficiency lead to iron deficiency anemia |
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What type of anemia is sickle cell anemia?
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microcytice anemia
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What anemias may be caused by impaired bone marrow function?
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anemia of chronic diseas, anemia of elderly
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What is hemolytic anemia?
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decreased RBC survival time due to destruction in the spleen or circulation
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What causes hemolytic anemia?
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RBC membrane defects, altered Hb solubility or stability and changes in intracellular metabolism
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What are s/s of acute onset anemia?
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cardiorespiratory symptoms: tachycardia, lightheadedness, breathlessness
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What are s/s of chronic anemia?
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weakness, fatigue, HA, vertigo, faintness, cold sensitivity, pallor, loss of skin tone
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What are s/s of iron deficiency anemia?
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glossal pain, smooth tongue, reduced salivary flow, pica (compulsive eating of nonfood items), pagophagia (compulsive eating of ice)
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What are s/s of Vitamin B12 and folate deficiency?
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pallor, icterus, gastric mucosal atrophy
Vitamin B12 has neuropsychiatric abnormalities (numbness, paresthesias, irritability) |
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What is the earliest most sensitive lab change for iron deficiency anemia?
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decreased serum ferritin (storage iron), also get decreased transferrin and increased total iron binding capacity
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What lab values for macrocytic anemia?
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increased mean corpuscular volume, hypersegmented polymorphonuclear leukocytes
B12 < 150 for B12 deficiency RBC folate < 150 for folate deficiency |
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How is anemia of chronic disease and anemia of critical illness diagnosed?
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exclusion of everything else
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What are characteristics of hemolytic anemias?
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normocytic, normochromic, increase reticulocytes, LD,indirect bilirubin
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What is goal of anemia tx?
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alleviate s/s, correct etiology, prevent recurrence
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What is does of oral iron for iron deficiency anemia?
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200mg elemental iron in 2-3 divided doses
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How does oral iron with a meal affect absorption?
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decreases by more than 50% but may need to improve tolerability
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What foods is iron best absorbed form?
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meat, fish, poultry
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Does parenteral iron hasten the onset of hematologic response?
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no
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Which parenteral iron products are better tolerated?
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sodium ferric gluconate and iron sucrose
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Which parenteral iron products are more effective?
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simmilar efficacy
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What is oral vitamin B12 supplement? How do you give for vitamin b12 deficiency anemia?
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cobalamin
1-2mg/day for 1-2 weeks, followed by 1mg daily |
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What is parenteral B12 supplement? How do you give it?
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cyanocobalamin, 100mcg/day for 1 week, then weekly for 1 month, then monthly
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When should parenteral vs oral therapy be used?
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if neurologic symptoms are present, more rapid acting
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When can pt switch from parenteral to oral B12?
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when symptoms resolve
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What is tx for folate deficiency anemia?
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folate 1mg daily for 4 months, 5mg if malabsorption present
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What is tx for anemia of chronic disease?
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focus on correcting reversible cause
iron therapy is not effective when inflammation present RBC transfusions may be effective Epoetin alfa |
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What is tx for anemia of critical illness?
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parenteral iron
epoetin alfa and RBC tansfusions not used |
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What is tx of anemia of prematurity?
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RBC transfusions
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What iron is used in peds?
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iron sulfate
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What is dose of iron in peds?
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3mg/kg for infants, 6mg/kg if over 4 weeks old
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What is daily dose of folate for peds?
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1-3mg
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What is tx for hemolytic anemia?
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correct underlying cause
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Which parenteral iron preparations have BBW?
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iron dextran and iron sucrose, anaphylactic reactions
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Which parenteral iron preparation is available as IM injection?
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iron dextran
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Which parenteral iron is given in dialysis line?
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iron sucrose
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Which parenteral iron is given in a higher dose?
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sodium ferric gluconate (125mg vs others are 100mg)
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What AE from sodium ferric gluconate?
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cramps, n/v, flushing, hypotension, rash, pruritus
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What AE from iron dextran?
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pain and brown staining at injection site, flushing, hypotension, fever, chills, myalgia, anaphylaxis
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What AE from iron sucrose?
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leg cramps, hypotension
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Ferrlecit
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sodium ferric gluconate
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InFed
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iron dextran
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Venofer
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iron sucrose
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How long for iron stores to be replenished in iron deficiency anemia?
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3-6 months
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How fast should iron replacement cause reticulocytosis and raise Hb?
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reticulocytosis in 5-7 days and raise Hb by 2-4 every 3 weeks
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When do s/s improve from megaloblastic anemia (B12 or Folate)?
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within a few days of starting B12 or folate
neurologic symptoms may take longer or may be irreversible, but shouldn't progress reticulocytosis in 2-5 days |
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When should Hb, leukocytes, platelets normalize in B12 deficiency?
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1 week after starting B12
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When should Hct normalize in folate deficiency?
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2 weeks after folate
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When does reticulocytosis occur in anemia of chronic disease?
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few days after starting epoetin alfa
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In anemia of chronic disease when should epoetin alfa be d/c?
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if no clinical response in 8 weeks
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