Therapeutics: Anemia 1

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  1. What classifies a man as having anemia?
    Hgb < 13 g/dL
  2. What classifies a woman as having anemia?
    Hgb < 12 g/dL
  3. What are the potential causes of Macrocytic anemia?
    Folic acid and B12 deficiency
  4. What is the initial test for a person suspected of having anemia?
    • CBC and RBC indexes
    • MCV
    • MCH
    • MCHC
  5. What RBC indice will be elevated with Macrocytic anemia?
    Mean corpuscular colume
  6. What is MCV?
    • Mean corpuscular volume
    • Average size of RBC
  7. What is MCH?
    • Mean corpuscular hemoglobin
    • Amount of Hgb is RBC
  8. What is MCHC?
    • Mean corpuscular Hgb concentration
    • Amount of HGB relative to size of RBC
  9. Serum iron levels has what downside?
    Can fluctuate from day to day
  10. Percentage transferring saturation is what?
    How much iron is bound
  11. What is the Total iron binding capacity?
    • Bloods capacity to bind iron
    • Serum iron/TIBC x 100
  12. When is TIBC high?
  13. When is TIBC low?
  14. When is Serum Ferritin low?
  15. When is Serum Ferritin commonly falsely elevated?
    Anemia of Chronic disease
  16. When is Red cell distribution width elevated?
  17. When are Erythropoietin levels increased?
    Hypoxia, IDA, hemolytic anemia
  18. When are Erythropoietin levels decreased?
    • Renal failure
    • Anemia of chronic disease
    • inflammation
  19. What tests are always done if a patient fails first round of testing for anemia?
    B12 an folic acid levels
  20. What tests can help differentiate between Folic acid and B12 deficiancy in anemia?
    Methylmalonic acid (MMA) = elevated in B12 deficiency only
  21. What are the three main causes of anemia?
    • Decreased RBC production
    • Blood loss
    • Excessive destruction of RBCs
  22. What are potential causes of anemia caused by decreased RBC production?
    • Iron deficiency
    • Kidney disease
    • Cancer
    • Erythropoetin deficiency
  23. What additional test would we run if any initial screens pointed toward anemia?
    • Serum Iron
    • Total iron binding capacity
    • Percentage transferring saturation
    • Serum Ferritin
    • Red cell distribution wdth
    • Erythropoitin levels
  24. What are the iron needs for males and post-menopausal women?
  25. What are the iron needs for menstruating females?
    18 mg/day
  26. What are the iron needs for children and pregnant women?
    Increased needs
  27. What is the treatment or Iron Deficiency anemia?
    • Dietary supplemtn
    • PO or IV iron
  28. What patients are high risk for IDA?
    • Pre-term infants
    • Chlidren < 2 years
    • Adolescent girls
    • Pregnant/lactating mothers
    • Elderly > 65
  29. What is severe iron deficiency in pregnancy?
    <6 g/dL
  30. What are the risks of IDA during pregnancy?
    • Low birth weight
    • Preterm delivery
    • Perinatal mortality
  31. What are the risks of severe (<6g/dL) IDA in pregnancy?
    • Abnormal fetal oxygenation
    • Reduced amniotic fluid
    • Fetal cerebral vasodilation
    • Fetal death
  32. What groups should be screened for 4-6 weeks post-partum for anemia?
    • Anemia into 3rd trimester
    • Excess blood loss during delivery
    • Multiple births
  33. How much iron should a pregnant woman get?
    30 mg/day
  34. What is the mainstay of IDA treatment?
    Dietary iron
  35. How much iron would you use in a supplement for the treatment of ID?
    • 200 mg elemental iron/day in 2 to 3 divided doses
    • Best on empty stomach b/c food decreases absorption
  36. What dietary modification would you try to treat IDA?
    • Increase Iron, particularly Heme iron
    • Limit milk and Tea
    • Add Vitamin C
  37. What are the most common SE for Iron?
    Nausea, vomiting, diarrhea, constipation and darkened stools
  38. Why is ferrous sulfate usually used at lest initially for IDA?
  39. What types of Oral iron products have less than 33% Iron?
    Ferrous sulfate, Ferrous gluconate and Ferrous fumarate
  40. What Oral iron products have 100% elemental iron?
    • Polysaccharide-iron complex
    • Carbonyl iron
  41. How should you monitor oral iron therapy for IDA?
    • Reticulocyte count in 1 week
    • Hgb should increase by 1 mg/dL Q1-2 weeks
    • Treat for 3-6 months and then see how they do without
  42. Would you get a faster response to Oral or IV iron?
  43. What group of patients should receive only IV iron?
  44. What reasons might a person fail Oral iron treatments?
    • Malabsorption
    • Continued bleeding
    • Misdiagnosis
    • Non-adherence
  45. What are eth pros and cons to Iron dextran
    • Cons: have to test before use
    • Pros: Can give all at once or in smaller doses over time (only one you can do this with)
  46. What are the parenteral iron supplements?
    • SFGC (Ferrlecit)
    • Iron sucrose (Venofer)
    • Ferumoxytol (Feraheme)
    • Ferric caboxymaltose (Injectafer)
  47. What is the dose for Ferumoxytol (Feraheme)?
    510 mg and repeated 3-8 days later
  48. What is the dose for Ferric Caboxymaltose (Injetafer)?
    750 mg weekly for 2 doses
  49. What should monitor weekly for a patient on IV iron?
    Hgb/Hct – Do not want them to go up to fast
  50. What should you monitor monthly for IV iron supplementation?
    • Serum Ferritin = want <800 ng/mL
    • Transferrin Saturation = want <50%
    • Serum Iron levels at least 48 hours after a dose
  51. Megaloblastic anemias create larger cells due to __________________ deficiency
    folic acid and vitamin B12
  52. What are the causes of Vit B12 deficient anemia?
    • Decreased absorption
    • Inadequate intake
    • Inadequate utilization
  53. What can decrease absorption of Vit B12?
    Gastric acid suppressing agents
  54. What is Pernicious anemia?
    • Subgroup of B12 deficiency
    • Lack intrinsic factor
  55. What test would you use to determine pernicious anemia?
    Schilling’s test
Card Set
Therapeutics: Anemia 1
Therapeutics: Anemia
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