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What is the etiology of Iron-deficiency anemia?
- Inadequate intake
- Inadequate iron absorption:
- TCNs (chelation)
- Blood loss:
- 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)
- chest pain
- decreased mental acuity
What are the lab values for Iron-deficiency anemia?
- Serum Fe
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
- 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
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
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?
- Reticulocyte count
- Serum B12
- 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?
What is monitored during B12 supplementation?
What is the etiology of Folic Acid deficiency anemia?
- Inadequate intake:
- Inadequate absorption:
What are the sx of Folic Acid deficiency anemia?
- similar to B12 deficiency minus neurologic sx and psych sx
What are the lab findings for Folic Acid deficiency anemia?
- Riticulocyte count
- Folic acid
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
- alcoholic liver disease
- 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?
- 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:
What are the SE of the erythropoietic drugs?
- bone pain
- thrombotic events
- pure red cell aplasia