In anemia, the tissue are not getting enough oxygen-rich blood. This results in the classic anemia symptoms. What are the symptoms?

What is pallor

What is glossitis

What is pica

Pallor: pale skin

Glossitis: inflamed tongue

Pica: craving and eating substances with poor nutritional value as ice or clay

A decreased oxygen supply means the organs have to overwork - this can cause systemic damage to many organs.

Anemia can cause heart damage. The heart will try to compensate for low oxygen levels by pumping faster (tachycardia) and by increasing the mass of the ventricular wall; this can eventually lead to heart failure

a type of macrocytic anemia that results in low B12 levels due to a lack of intrinsic factor

Difference in dosing between prescription Folic Acid and OTC Folic Acid

Rx Folic Acid: 1 mg

OTC Folic Acid:  0.4 and 0.8 mg

in renal disease, due to a lack of erythropoietin, the MCV may be normal - this is called normocytic anemia

YES!

The drug will not work if iron stores are low. And this drug is expensive - you'll be fired should you now check the iron levels!

The majority of patients who need iron replacement are able to use _______. The majority of patients who receive iron by injection are on ______.

Hemoglobin (HGB):

Normal for males

Normal for females

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Males: 13-18 g/dL

Females: 12 - 16 g/dL

Hematocrit (HCT):

Normal for males

Normal for females

Males: 37 -49 %

Females: 36 - 46%

Why would contraceptives be dispensed to young women (aside from the pregnancy aversion)

Women taking hormone contraception experience less bleeding during their periods and therefore have a lower risk of developing an iron deficiency.

Younger women have heavier blood loss.

stomach upset (nausea)

constipation; recommend a stool softener such as docusate

the effect of iron supplementation may be seen in ~3 weeks and the treatment should last until 3-6 months after RBCs, iron stores and other labs have normalized

Yes. Iron is dark and most is not absorbed. People using iron will find their stool is darker. This is not a sign of GI bleeding.

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Acidic

Iron requires an acidic environment. Therefore, a patient should be cautious about which kind of drugs?

Yes (unfortunately); accidental iron poisoning is the leading cause of poisoning deaths amoung young children

IF A PARENT SUSPECTS THEIR CHILD TOOK IRON PILLS OR LIQUID, THEY SHOULD BE DIRECTED TO THE NEAREST EMERGENCY ROOM IMMEDIATELY

[image][image][image][image]T[image]Wikipedia: T is the 20th letter in the ISO basic Latin alphabet. →

Statement. Not a question.

Deferoxamine

(get it: de-ferrous...)

Hemodialysis

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ESAs are not longer first-line for anemia b/c most forms of anemia aren't life-threatening. Name black blox warnings for the use of ESAs.

Renal Failure: dosing should be individualized to achieve and maintaiin Hgb levels within the range of 10 -12 g/dL.  For epoetin alpha (Procrit, Epogen), start at 50-100 u/kg given TIW, given SC if not on dialysis, or IV at dialysis treatments. Once-weekly darbepoetin (Aranesp) is started at 0.45 mcg/kg weekly and adjusted per hemoglobin levels.

Cancer: ESAs shortened overall survival and/or increased risk of tumor progression.

Perisurgery: ESAs increased the rate of deep venous thromboses in patients not receiving prophylactic antigoagulation. Consider deep venous thrombosis prophylaxis.

10 g/dL

The prescriber must be enrolled and certified by the ESA APPRAISE Oncology Program. The patient must sign a form that states they have received counseling about risks and benefits.

Transferrin saturation should be at least ____% and ferritin should be at least ____ ng/mL prior to starting ESA treatment.

20; 100

CHF, chest pain, thrombosis, arrthmias, cardiovascular death, seizures and in some cases acceleration of tumor growth (hence the APPRAISE)