Term
| Three signs of iron deficiency anemia |
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Definition
| Koilonychia, angular stomatitis and glossitis, pica |
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Term
| Labs for iron deficiency anemia (serum iron, ferritin, TIBC, Hgb, Hct, RBC) |
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Definition
| Serum iron is low, ferritin is low, TIBC is high, Hgb/Hct/RBC all are normal at first but then drop |
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Term
| Which form of iron is better absorbed and where do you get this form from? |
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Definition
| Heme iron (meats) is better absorbed than non-heme iron (vegetables, supplements) |
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Term
| What decreases the absorption of iron and what increases the absorption of iron? |
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Definition
| Milk and tea decrease the absorption; gastric and ascorbic acid increase the absorption of non-heme iron |
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Term
| What is the difference between enteric coated and non-enteric coated iron? |
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Definition
| Enteric coated iron is absorbed in the small intestine (decreased overall absorption); non-enteric coated is absorbed in duodenum (increased absorption) |
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Term
| How can you increase the tolerability of oral iron? |
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Definition
| Take smaller, more frequent doses; take with food or decrease the dose to 110-120 mg elemental iron instead of 200 mg |
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Term
| With iron deficiency anemia, what happens to the reticulocytes and the Hgb after starting therapy? |
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Definition
| Reticulcytes increase in 5-7 days; Hgb increases by 2-4 g/dL every 3 weeks but rate of increase slows as it reaches normal |
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Term
| How long after iron deficiency anemia is resolved do you need to continue supplementation to replace lost stores? |
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Definition
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Term
| If iron loss is continual problem (menstruation) how much iron should the person receive per day? |
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Definition
| 30-60 mg after the initial anemia resolves to prevent relapse |
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Term
| What are four parenteral iron formulas? |
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Definition
| Iron dextran, iron sucrose, sodium ferric gluconate, ferumoxytol |
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Term
| What are the two ways to administer iron dextran? |
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Definition
| IV or IM by z-track method (may cause pain, staining of skin, tissue necrosis, atrophy) |
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Term
| Adverse effects of oral iron? |
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Definition
| Dark feces, constipation, N/V/D |
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Term
| Main AE of parenteral iron? |
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Definition
| If history of asthma, allergies, RA or SLE more likely to have anaphylaxis (this is why you need to give a test dose and observe for one hour before giving the remainder of the dose and have epinephrine or diphenhydramine nearby) |
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Term
| What medication decreases the absorption of Vitamin B12? |
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Definition
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Term
| Signs and symptoms of Vitamin B12 deficiency anemia? |
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Definition
| Neurologic, glossitis, dysphagia, anorexia |
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Term
| Labs of Vitamin B12 deficiency anemia (MCV, reticulocytes, B12, Hct) |
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Definition
| Increased MCV (macrocytic), low reticulocytes, B12 and Hct; hypersegmented polymorphic leukocytes; mild leukopenia and thrombocytopenia |
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Term
| When giving oral B12 therapy, what two conditions would make you need to give more than the normal 1-2 mg/day? |
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Definition
| Pernicious anemia, ileal resection |
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Term
| When do you use parenteral B12 and how often is it given? |
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Definition
| Neurological symptoms; 1 mg every day for a week, then 1 mg every week for a month, then 1 mg per month; switch to oral once neurological symptoms resolve |
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Term
| What advantages dose nasal B12 therapy have over oral? |
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Definition
| None, plus its more expensive |
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Term
| When do reticulocytes, and Hgb, thrombocytopenia and leukopenia start to resolve? |
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Definition
| Reticulocytes improve within 2-5 days; Hgb, thrombocytopenia and leukopenia start to normalize within one week |
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Term
| Adverse effects of B12 therapy? |
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Definition
| Hyperuricemia, hypokalemia, anaphylaxis, rebound thrombocytosis, sodium retention (espcially with pre-existing heart problems) |
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Term
| What are dietary sources of folic acid? |
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Definition
| Fresh fruits and vegetables, yeast, mushrooms, animal organs |
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Term
| What is the RDA of folic acid for men and women? |
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Definition
Men: 50-100 mcg
Women: 400 mcg (600 if pregnant) |
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Term
| What medications can cause folic acid deficiency? |
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Definition
Medications that inhibit DNA synthesis (azathioprine, 6-mercaptopurine, 5-fluorouricil, hydroxyurea, zidovudine)
Medications that are folate antagonists (methotrexate, pentamidine, trimethoprim, triamterene)
AED's (phenytoin, phenobarbital, primidone, carbamazepine) |
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Term
| Labs for folic acid deficiency anemia |
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Definition
Same as for B12 but B12 is normal
Decreasd serum and RBC folate (RBC folate is less sensitive to daily changes) |
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Term
| What will happen to reticulocytes, MCV and Hct after starting folic acid therapy? |
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Definition
| Reticulocytes start to increase in 2-3 days; Hct will begin to rise in 2 weeks (normal after 2 months); MCV will initially rise but then normalize |
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Term
| Laboratory findings in anemia of chronic disease? (iron, ferritin, TIBC) |
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Definition
| Decreased serum iron, increased ferritin, decreased TIBC |
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Term
| WHen should you use EPO with anemia of chronic disease and what level should you check if you do start EPO therapy? |
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Definition
| Not if the EPO level is >150 (check Hgb every two weeks during therapy and possibly supplement with iron) |
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Term
| WHat are the two treatments for anemia of chronic renal failure and what are the goals for each? |
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Definition
Epoetin alpha: Hct 36%
Darbepoetin alfa: Hgb of 12 g/dL |
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Term
| What deficiency to you have to watch out for if you start EPO therapy for anemia of CRF? |
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Definition
| Iron deficiency due to increased erythropoiesis (supplement with 325 mg qHS to prevent) |
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