Therapeutics: Anemia 1
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What classifies a man as having anemia?
Hgb < 13 g/dL
What classifies a woman as having anemia?
Hgb < 12 g/dL
What are the potential causes of Macrocytic anemia?
Folic acid and B12 deficiency
What is the initial test for a person suspected of having anemia?
- CBC and RBC indexes
What RBC indice will be elevated with Macrocytic anemia?
Mean corpuscular colume
What is MCV?
- Mean corpuscular volume
- Average size of RBC
What is MCH?
- Mean corpuscular hemoglobin
- Amount of Hgb is RBC
What is MCHC?
- Mean corpuscular Hgb concentration
- Amount of HGB relative to size of RBC
Serum iron levels has what downside?
Can fluctuate from day to day
Percentage transferring saturation is what?
How much iron is bound
What is the Total iron binding capacity?
- Bloods capacity to bind iron
- Serum iron/TIBC x 100
When is TIBC low?
When is Serum Ferritin low?
When is Serum Ferritin commonly falsely elevated?
Anemia of Chronic disease
When is Red cell distribution width elevated?
When are Erythropoietin levels increased?
Hypoxia, IDA, hemolytic anemia
When are Erythropoietin levels decreased?
- Renal failure
- Anemia of chronic disease
What tests are always done if a patient fails first round of testing for anemia?
B12 an folic acid levels
What tests can help differentiate between Folic acid and B12 deficiancy in anemia?
Methylmalonic acid (MMA) = elevated in B12 deficiency only
What are the three main causes of anemia?
- Decreased RBC production
- Blood loss
- Excessive destruction of RBCs
What are potential causes of anemia caused by decreased RBC production?
- Iron deficiency
- Kidney disease
- Erythropoetin deficiency
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
What are the iron needs for males and post-menopausal women?
What are the iron needs for menstruating females?
What are the iron needs for children and pregnant women?
What is the treatment or Iron Deficiency anemia?
- Dietary supplemtn
- PO or IV iron
What patients are high risk for IDA?
- Pre-term infants
- Chlidren < 2 years
- Adolescent girls
- Pregnant/lactating mothers
- Elderly > 65
What is severe iron deficiency in pregnancy?
What are the risks of IDA during pregnancy?
- Low birth weight
- Preterm delivery
- Perinatal mortality
What are the risks of severe (<6g/dL) IDA in pregnancy?
- Abnormal fetal oxygenation
- Reduced amniotic fluid
- Fetal cerebral vasodilation
- Fetal death
What groups should be screened for 4-6 weeks post-partum for anemia?
- Anemia into 3rd trimester
- Excess blood loss during delivery
- Multiple births
How much iron should a pregnant woman get?
What is the mainstay of IDA treatment?
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
What dietary modification would you try to treat IDA?
- Increase Iron, particularly Heme iron
- Limit milk and Tea
- Add Vitamin C
What are the most common SE for Iron?
Nausea, vomiting, diarrhea, constipation and darkened stools
Why is ferrous sulfate usually used at lest initially for IDA?
What types of Oral iron products have less than 33% Iron?
Ferrous sulfate, Ferrous gluconate and Ferrous fumarate
What Oral iron products have 100% elemental iron?
- Polysaccharide-iron complex
- Carbonyl iron
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
Would you get a faster response to Oral or IV iron?
What group of patients should receive only IV iron?
What reasons might a person fail Oral iron treatments?
- Continued bleeding
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)
What are the parenteral iron supplements?
- SFGC (Ferrlecit)
- Iron sucrose (Venofer)
- Ferumoxytol (Feraheme)
- Ferric caboxymaltose (Injectafer)
What is the dose for Ferumoxytol (Feraheme)?
510 mg and repeated 3-8 days later
What is the dose for Ferric Caboxymaltose (Injetafer)?
750 mg weekly for 2 doses
What should monitor weekly for a patient on IV iron?
Hgb/Hct – Do not want them to go up to fast
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
Megaloblastic anemias create larger cells due to __________________ deficiency
folic acid and vitamin B12
What are the causes of Vit B12 deficient anemia?
- Decreased absorption
- Inadequate intake
- Inadequate utilization
What can decrease absorption of Vit B12?
Gastric acid suppressing agents
What is Pernicious anemia?
- Subgroup of B12 deficiency
- Lack intrinsic factor
What test would you use to determine pernicious anemia?
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