-
What can cause Cobalamin malabsorption?
- Low Gastric acid secretion
- Due to gastrecotmy or prolonged gastric acid suppression
-
What can cause Decreased B12?
- Pernicious anemia
- Cobalamin malabsorption
-
What drugs can cause Vitamin B12 deficiency?
- Antibiotics
- Anticonvulsants
- Cytotoxic agents
- Oral contraceptives
- High dose Vitamin C
-
What symptoms other than traditional pallor, SOB and fatigue, might you see in B12 deficiency?
- Neuropsychiatric – May be irreversible
- e.g. muscle weakness, dementia, mental status changes, ataxia
-
What is the treatment for Vitamin B12 deficiency?
- Dietary
- Oral replacement with Cobalamin – 1 mg/day
- PO unless having neuropsychiatric problems – then use IV or IM (cyanocobalamin)
-
What is the intial dose for cyanocobalamin/cobalmain (B12)?
1000 mcg
-
What is the intranasal gel Vitamin B12 formulation used for?
Mainenance only, because edose is only 500 mcg (half of what a repletion dose would be)
-
What counseling needs to be done for intranasal Vit B12?
Do not administer 1 hr before or after hot food/beverages
-
What is the IV/IM form of B12?
Cyanocobalamin
-
What is the PO form of B12?
Cobalamin
-
What are the SE for B12 therapy?
- HYPERuricemia
- HYPOkalemia
- Thrombosis
- Fluid retention
- Anaphylaxis (IV/IM)
-
What should you monitor on B12 therapy?
- HgB – should normalize in 1-2 months
- CBC and B12 levels after 1-2 months and then every 3-6 months
-
What are the sources of folic acid?
Fresh, green leafy veggies, citrus fruits, yeast, mushrooms, animal organs
-
What groups are most at risk for folic acid deficiency?
- Pregnant
- Excessive alcohol intake
- Elderly
-
What are most cases of FA deficiency caused by?
Alcohol
-
What are the four ways that FA deficiency usually develops?
- Inadequate intake
- Decreased absorption
- Hyperutilization
- Inadequate utilization
-
Folic acid deficiency anemia has what signs and symptoms?
- Normal: SOB, fatigue, pallor
- Similar to B12 but with NO NEUROPHSYCOLOGICAL
-
The lab values for FA deficiency would differ from B12 in what way?
- Nomral B12 levels and normal MMA
- Decreased Folate <3 ng/mL
-
What is the treatment for FA deficiency?
- 1 mg/day
- Up to 5 mg/day for malabsorption causes
- 4 month therapy, unless chronic
- Increase dietary
-
How much FA do pregnant women need?
- 1 mg/day to prevent neural tube defects
- Previous neural tube defects = 4 mg/day
-
Increased Morbidity and Mortality for Anemia of Chronic disease, occurs in patients with what chronic diseases?
HIV and CHF
-
What are the causes of Anemia of Chronic Disease?
- Shortened RBC lifespan
- Decreased response to EPO
- Disturbance of iron metabolism
- Impaired proliferation of erythroid progenitor cells
-
How is a diagnosis of Anemia of chronic disease made?
By ruling out other causes
-
What is the treatment for Anemia of Chronic disease?
- Correct underlying disease if possible
- Transfusion
- Epoetin Alfa
-
When can you initiate Transfusions for Anemia of Chronic DIsease?
HgB <8
-
When should you stop Epoetin alpha therapy?
- If HgB goes over 11 g/dL
- Should not go over 1 g/dL in 2 weeks
-
What dosing of EPO is preferred for dialysis patients?
3x/weekly dosing is preferred for dialysis patients as they have better response
-
For non-dialysis patients what dosing of EPO is preferred?
Weekly
-
What needs to be monitored when giving EPO?
Hgb rate of increase and total levels
-
If Hgb increases by > 1 g/dL in 2 weeks on EPO therapy, what should you do?
Decrease dose by 25-50%
-
What is the risk of Hgb increasing by > 1 g/dL in 2 weeks on EPO therapy?
Increased risk of HTN and seizures
-
If Hgb increases above > 11 g/dL on EPO therapy, what should you do?
Hold doses until Hgb falls below 11
-
What is the risk of Hgb increasing by > 1 g/dL in 2 weeks on EPO therapy?
Increased risk of Thromboembolism and mortality
|
|
