1. anemia
    a hematologic sign of another disease process occuring within the body which results in heightened destruction of RBCs, a dec prod of RBCs, or an acute loss of RBCs
  2. immature erythrocytes
  3. hormone released when o2 concentrations decrease
    EPO, kidney stimulates the release
  4. EPO signals stem cells within bone marrow to produce reticulocytes and is responsible for:
    stimulating cell differentiation, increasing amt of reticulocytes released from bone marrow, and signaling an increase in hemoglobin production
  5. iron is transported to bone marrow by:
    transferrin, excess iron known as ferritin or hemosiderin in the liver, spleen, and bone marrow
  6. erythrocyte dev also requires additional cofactros including:
    vitamin B12 and folate
  7. erythrocytes remain in circulation approx
    120 days, then undergo destruction and recycling by macrophages
  8. Hemoglobin (Hb) lab value, what it is and normal values for men and women?
    • measures the ability of the RBC to carry oxygen
    • Men: 13-18g/dL
    • Women: 12-16 g/dL, factors that can increase Hb:smoker, higher alt, diff ethnic groups
  9. Hematocrit, what is and normal ranges
    • percentage of RBCs to TOTAL blood volume,
    • Men: 41-53%
    • Women: 36-46%
  10. Anemia is defined as a decrease in (___ and ___) below normal ranges
    hemoglobin OR hematocrit
  11. mean corpuscular volume (MCV)
    average RBC volume, normal range:80-100fL
  12. types of anemias based on MCV
    microcytic, macrocytic, or normocytic
  13. microcytic anemia
    <80 fL, RBCs are small
  14. examples of microcytic anemia
    iron deficiency anemia (IDA), thalassemia, anemia of chronic disease, sideroblastic
  15. normocytic anemia
    80-100fL, normal sized cells
  16. examples of normocytic anemia
    acute blood loss, hemolytic anemia, anemia of chronic disease, anemia of chronic kidney disease, mixed anemia
  17. macrocytic anemia
    >100fL, large cells
  18. examples of macrocytic anemia
    vitamin B12 deficiency anemia, folate deficiency anemia
  19. mean corpuscular hemoglobin (MCH)
    • Hb/RBC count
    • normal: 26-34 pg
  20. mean corpuscular hemoglobin concentrations (MCHC)
    • Hb/Hct
    • normal: 31-37%
  21. red blood cell distribution width (RDW)
    • variance btwn RBC sizes within a given sample
    • normal: 11-16&
    • can be a helpful measure to look at in the case of mixed anemias (greatly increased)
  22. reticulocyte count
    measurement of new RBC production, used to calc reticulocyte production index (RPI) to determine if bone marrow is responding adeq to the RBC needs of the body
  23. RPI value indicated an inadequate response of the bone marrow
  24. decreased Hb/Hct with normal RPI indicates:
    blood loss or a hemolytic anemia
  25. decreased Hb/Hct with decreased RPID
    indicates anemia by another cause
  26. acute onset of anemia
    severe cardiovascular and respiratory symptoms incuding tachycardia, lightheadedness, shortness of breath, decreased blood pressure
  27. chronic onset of anemia
    wide variety of symptoms including, but not limited to HA, dizziness, weakness, feeling tired, and senstivity to cold
  28. prevalence of IDA
    • men-2%
    • women-9-12%
    • african amer/hisp women-approximately 20%
  29. causes of IDA
    • abnormal iron balance: dec intake, inade abs or dietary iron, blood loss(i.e.menstruation)
    • increased physiologic need: prenancy/lactation, infants, adolescence
  30. serum iron
    • conc of iron bound to transferrin
    • normal male: 50-160 mcg/dL
    • female: 40-150 mcg/dL,
    • in IDA, serum iron may be decreased or normal
  31. total iron binding capacity (TIBC)
    measure of the ability of transferrin to bind additional iron, normal range: 250-450 mcg/dL, can be used to differentiate diagnosis
  32. TIBC >400 mcg/dL
    likely IDA
  33. TIBC <200 mcg/dL
    likely inflammatory disorder and not IDA
  34. transferrin saturation
    • shows the amt of iron avail for the prod of RBC
    • normal: 20-50%
    • in IDA, transferring sat <=15%
  35. ferritin
    • meas of the amt of iron currently being stored in the body
    • normal male: 15-200ng/ml
    • female: 12-150 ng/ml
    • in IDA, ferritin is ALWAYS decreased
  36. signs and sx specific to IDA
    • PICA (cravings for nonfood items)and Pagophagia (cravings for ice)
    • Koilonychia (spooning of the nails), seen more in elderly
  37. typical starting dose of oral iron supplement
    first line ror IDA, 200 mg elemental iron d, 2-3 divided doses, increasing freq can improve tolerability, best on empty stomach at least one hour b4 meals but food dec GI upset, dk colored stools
  38. meds that dec iron abs
    alum. mg, and calc containing antacids, H2 antag, PPIs, and tetracycline
  39. common meds whose abs is decreased by iron:
    levodopa, levothyroxine, fluroquinolones, and tetracycline
  40. monitoring for oral iron preparations
    Hb should increase 1-2g/dL weekly with 200 mg elemental dose, tx for 3-6mo post resolution of IDA to re-build iron stores, pts requiring long-term therapy often req d small daily doses (30-60mg pf elemental iron)
  41. parenteral iron preparations, when and which ones
    pt unable to correctly absorb iron from the Gi tract, pt has a hx of long-term noncompliance w oral replacement therapy, and/or pt is intolerant of oral replacement therapy, sodium ferric gluconate (ferrlecit), iron sucrose (venofer), iron dextran-black box for anaphylaxis
  42. ways to give IV iron
    as multiple slow inj of undiil soln (not to exceed 50 mg, 1 mL per minute) dose limited to 2mL (100mg) daily in adults, or IM via Z-tract inj technique to minimize staining, max IM dose:2 ML (100mg) d in adults or total dose inf (non fda-approved), dilute in NS or D5w and give as a total dose inf over 4-6 hours
  43. test dose of InFed
    25 mg (0.5mL)IM or IV, over 30 seconds
  44. test dose of DexFerrum
    25 mg (0.5mL)IM or IV, over 5 minutes
  45. test dose of total dose infusion soln
    diluted total dose inf soln 5-10 min inf of the diluted total dose soln, if no adverse effect/anapylaxis after 1 hour, then remainder of dose may be given
  46. AEs of parenteral iron
    • imm: pain at inf site, discoloration/staining at inf site, allergic rxns/anaphylaxis
    • delayed: joint pain, muscle pain, fever, HA, dizziness, N&V
  47. monitoring of parenteral iron
    increased liver fxn tests, ferritin>800ng/mL, transferrin saturation >50%, monitor Hb, Hct weekly, iron and ferritin monthly
Card Set