-
What is the etiology of Iron-deficiency anemia?
- Inadequate intake
- Inadequate iron absorption:
- antacids
- H2-blockers
- PPIs
- TCNs (chelation)
- Blood loss:
- ASA
- Alcohol
- NSAIDs
- Steroids
- Increased demand
-
What is the pathophysiology of Iron-deficiency anemia?
- Prelatent: iron stores are reduced but serum levels remain normal; Hb normal
- Latent: iron stores depleted; Hb declines, but stays above lower limit
- Iron-deficiency anemia: Hb drops below lower limit
-
What are the sx of Iron-deficiency anemia?
- glossitis (inflammation of the tongue)hair loss
- koilonychia (spoon nails)
- pica (compulsive eating of non-food items)
- stomatitis (inflammation of the mouth)
- fatigue
- dizziness
- irritability
- weakness
- palpitations
- vertigo
- SOB
- chest pain
- tachycardia
- pale
- decreased mental acuity
-
What are the lab values for Iron-deficiency anemia?
- HB
- HCT
- MCV
- RDW
- Serum Fe
- TIBC
- TSAT
- Ferritin
-
What is the tx for Iron-deficiency anemia?
- Ferrous sulfate
- Ferrous gluconate
- Ferrous fumerate
- Polysaccharide iron complex
- Carbonyl iron
-
What is the dose and duration of tx for Iron-deficiency anemia?
- Ferrous Sulfate 325mg PO TID
- Elemental Fe 200mg PO BID-TID
- Dexferrum/INFeD 50mg/mL IM
-
What are the SE of iron supplementation?
- dark feces
- constipation
- N/V
- Abdominal cramps
- separate from cations, FQs, TCNs, thyroid by 2hrs
-
What should be monitored for Iron-deficiency anemia?
- Reticulocytes should increase in 5-7d
- Hb should increase 2-4g/dL q 3wks
- Compliance
- SE
- DI
-
What are the characteristics of parenteral iron (Dexferrum/INFeD)?
- IM only
- use Z-track technique
- SE: brown staining, hypotension, anaphylaxis (do a 0.5mL test dose)
-
What is the etiology of Vitamin B12 deficiency anemia?
- Inadequate intake
- Pernicious anemia
- Malabsorption:
- antacids
- H2-blockers
- PPIs
- Metformin
-
What is the pathophysiology of B12 deficiency anemia?
impairs DNA and RNA nucleic acid synthesis in the immature RBC which impairs mitotic cell division and maturation producing large immature RBCs
-
What are the sx of B12 deficiency anemia?
- Neurologic: numbness, paresthesias, peripheral neuropathy, ataxia, diminished vebratory sense, decreased proprioception, imbalance, possible vision changes
- Psychiatric: irritability, personality changes, memory impairment, dementia, depression, psychosis (rare)
-
What are the lab findings of B12 deficiency anemia?
- Hb
- HCT
- MCV
- Reticulocyte count
- Serum B12
- WBC
- Platelets
- Methylmalonic acid test is elevated (v. diagnostic for B12 deficiency)
- Anti-intrinsic factor antibody test
- Anti-parietal cell antibody test
-
What is the tx for B12 deficiency anemia?
- 1000mcg PO QD
- 1000mcg IM QD or QOD
- Maintenance only: Nascobal or CaloMist intranasal
-
What are the SE of B12 supplementation?
- hyperuricemia
- hypokalemia
- anaphylaxis
-
What is monitored during B12 supplementation?
- Hb
- Hct
- Reticulocytes
- B12
- compliance
-
What is the etiology of Folic Acid deficiency anemia?
- Inadequate intake:
- alcoholism
- Inadequate absorption:
- methotrexate
- pentamidine
- TMP
- triamterene
- 5-FU
- hydroxyurea
- pyrimethamine
- phenytoin
- phenobarbital
- primidone
- Hyperutilization
-
What are the sx of Folic Acid deficiency anemia?
- Vague
- similar to B12 deficiency minus neurologic sx and psych sx
-
What are the lab findings for Folic Acid deficiency anemia?
- Hb
- Hct
- MCV
- Riticulocyte count
- Folic acid
- WBC
- Platelets
-
What is the tx for Folic Acid deficiency anemia?
Folic acid 1mg PO QD
-
Why must B12 deficiency be ruled out before treating Folic Acid deficiency?
so you don't ignore neurologic sx if they also have B12 deficiency
-
What is the etiology of Anemia of Chronic Disease?
- chronic infections
- chronic inflammation
- malignancies
- alcoholic liver disease
- CHF
- thrombophlebitis
- COPD
- ischemic heart disease
-
What is the pathophysiology of Anemia of Chronic disease?
immune activation causes inflammatory cytokine production which reduces iron availability, impaired erythrocyte proliferation, impaired erythropoietin production, and shortened RBC lifespan
-
What are the Sx of Anemia of Chronic Disease?
often overshadowed by the sx of the underlying disorder
-
What are the lab findings for Anemia of Chronic Disease?
- Hb
- Hct
- MCV
- Fe
- TIBC
- TSAT
- Ferritin
- Reticulocyte count
-
What is the tx for Anemia of Chronic Disease?
- correct underlying disease (not usually)
- RBC transfusion if < 8
- Iron supplementation (if Fe deficient)
- Erythropoiesis-stimulating agents:
- Epogen
- Procrit
- Aranesp
-
What are the SE of the erythropoietic drugs?
- HTN
- bone pain
- seizures
- thrombotic events
- pure red cell aplasia
|
|
