Term
| What are the threshold concentrations for anemia in men and women? |
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Definition
Men: below 13mg/dl
Women: below 12mg/dl |
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Term
| Describe the Erythrocyte Maturation Sequence. |
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Definition
| Pluripotent Stem Cell-> Erythroid burst-forming unit-> EPO-> Erythroid Colony forming unit-> EPO-> Proerythroblast-> Basophilic Erythroblast-> Polychromic Erythroblast-> Pyknotic Erythroblast-> Bone Marrow Reticulocyte-> Peripheral Reticulocyte (when leaves bone marrow)-> Mature Erythrocyte |
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Term
| Where is most EPO produced and how does it work? |
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Definition
| 90% produced in the kidneys. Prevents apoptosis of erythroid precursor cells. Decrease in tissue O2 conc signals increased production of EPO. |
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Term
| What are 6 symptoms of acute onset anemias? |
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Definition
1. Tachycardia
2. Lightheadedness
3. Palpitations
4. Angina
5. Hypotension
6. Dyspnea |
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Term
| What are 8 Symptoms of chronic onset anemia? |
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Definition
1. Weakness
2. Fatigue
3. Headache
4. Vertigo
5. Faintness
6. Symptoms of Heart Failure
7. Sensitivity to Cold
8. Loss of skin tone and pallor |
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Term
| What tests are done to initially evaluate for anemia? |
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Definition
1. CBC (hb, hct, WBC, Platelets)
2. RBC count and MCV
3. Peripheral Smear
4. Stool Sample for occult blood |
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Term
| What are the Lab values and Tests done to evaluate anemias? |
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Definition
Hemoglobin
Hematocrit
RBC count
MCV
MCH
MCHC
Total Reticulocyte Count
Red Blood Cell distrobution width
Peripheral Blood Smear
Serum Iron
TIBC
TSAT
Serum Ferritin
Folic Acid
Vitamin B12
Coombs Test
Schilling Test |
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Term
| What are the reference Ranges for men and women hemoglobin? What does this test tell you? |
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Definition
Men: 14-17.5
Females: 12.3-15.3
Estimate of O2 carrying capacity of the blood. |
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Term
| What are the reference ranges of hematocrit for men and women? What does this test tell you? |
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Definition
Men: 42-50%
Women: 36-45%
Decreased hematocrit= decrease in number of RBCs or an increased in plasma volume. |
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Term
| What is the reference range for serum Iron ? |
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Definition
|
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Term
| What is the referance range for total iron binding capacity? |
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Definition
|
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Term
| What is the reference range for Transferrin saturation (TSAT)? |
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Definition
30-50%
Extent to which iron binding sites are vacant on transferrin and indicates the amount of iron readily available for erythropoesis. |
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Term
| What is the reference range for serum ferritin? |
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Definition
>10-20 mcg/L
Indicates amount of iron stored in the liver, spleen and bone marrow cells. Best indicator of iron deficiency or iron overload. |
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Term
| What is the reference range for folic acid in the plasma? |
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Definition
Plasma: 3.1-12.4 ng/ml
A decrease in folic acid level indicates folate deficiency megaloblastic anemia. |
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Term
| What is the reference range for Vitamin B12? |
|
Definition
|
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Term
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Definition
| Antiglobulin test that indicates hemolytic anemia caused by an immune response. |
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Term
| What is a schilling test? |
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Definition
Urinary excretion test to diagnose vitamin B12 deficiency anemia caused by B12 absorption defect resulting from lack of intrinsic factor.
Usefulness not known. |
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Term
| What are 4 groups at high risk for iron deficiency? |
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Definition
1. Children under 2 years old.
2. Adolescent Girls
3. Pregnant Females
4. Elderly > 65 years old
Iron is used for the formation of Hbg in the body. |
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Term
| What are the recomended dietary allowances of iron for males, postmenopausal females, and menstruating females? |
|
Definition
Males: 8mg
Postmenopausal Females: 8mg
Menstruating Females: 18mg |
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Term
| Iron is best absorbed in the _____ form. |
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Definition
Ferrous (Fe 2+)
Fe 3+ is ionized in stomach acid, then reduced to Fe 2+. |
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Term
| Iron is transported by _____ to ______, ______, and ______. |
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Definition
| Transferrin, Muscles (Myoglobin), Liver (Storage), Bone Marrow (Incorporated into HB) |
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Term
| Name 4 Early lab findings in iron deficiency anemia. |
|
Definition
-Serum Iron
-Serum Ferritin
-TSAT%
+TIBC |
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Term
| Name 3 common symptoms of anemia. |
|
Definition
Headache
SOB
Cardiovascular symptoms |
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Term
| Name 6 symptoms that are relatively specific to iron deficiency anemia. |
|
Definition
Glossitis
Reduced Salivary Flow
Pica
Pagophagia
Koilonychia
GI |
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Term
| In the initial treatment of IDA, what amount of oral elemental iron is given daily? |
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Definition
| 200mg divided into 2-3 doses |
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Term
| Why is enteric coated oral iron not recomended? |
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Definition
| Transported past the duodenum and proximal jejunum-> reduces absorbsion of iron. |
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Term
| Which form of iron is the formulation of choice? |
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Definition
| Ferrous Sulfate (exsiccated)- has 30% elemental iron - used due to tolerability, effectiveness, and low cost. |
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Term
| What would an appropriate initial dose for Ferrous Sulfate be? What would one monitor to ensure the medicine is working? |
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Definition
| FeSO4 325mg tid. Take one hour before or 2 hours after meals. Monitor Hb-should rise 2-4mg/dl every 3 weeks. Same for parenteral. |
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Term
| Name some side effects associated with oral iron therapy. |
|
Definition
GI
-Dark discoloration of feces
-Constipation
-Abdominal Cramping
-N/V
-Most will develop at least some GI side effects. |
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Term
| Name some important counseling points with iron therapy. |
|
Definition
1. keep out of reach of children.
2. Take on empty stomach for optimal absorbsion.
3. Take 2 hours before or after interacting drugs.
4. Combine with stool softener/laxitive to prevent constipation.
6. Continue Treatment for 3-6m after anemia is resolved. |
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Term
| Under what 4 circumstances is Parenteral Iron therapy indicated? |
|
Definition
1. Iron malabsorbsion
2. Intolerance of orally administered iron.
3. Long Term non-adherance.
4. Patients with significant blood loss due to transfusions. |
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Term
| T/F: Parenteral Iron leads to a quicker hematologic response than oral iron. |
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Definition
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Term
| Which parenteral iron preparations have black box warnings? Which does not? |
|
Definition
Black Box Warning: Iron Dextran (Test dose Required) and Iron Sucrose
No BBW: Sodium Ferric Gluconate and Ferumoxytol (Faraheme) |
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Term
| What is the usual dosing for Sodium Ferric Gluconate? |
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Definition
| 125mg diluted in 100ml normal saline, infused over 60 mins. Can also be infused as a slow IV injection (12.5mg/min). 8 Doses x 125mg = 1000mg |
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Term
| What is the usual dosing for parenteral Iron Dextran? |
|
Definition
Intermittent Doses IM or IV:
TEST DOSE= 0.5ml (25mg)
Rate= 50mg/min undiluted
Max Daily Dose= 100mg (2ml)
Total Infusion:
Test Dose 25mg
1000mg diluted dose in 250-1000ml 0.9% saline and infuse over 2-6 hours
10 doses x 100mg = 1000mg |
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Term
| What is the usual dosing for Iron Sucrose? |
|
Definition
100mg IV into the dialysis line at 1ml(20mg)/min.
Up to 10 doses x 100mg = 1000mg |
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Term
| What is the indication and dosing for Ferumoxytol (Faraheme)? |
|
Definition
Indicated for IDA in adult patients with CKD.
Dose: Initial 510mg IV injection, then second 510mg IV injection 3-8 days later. |
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Term
| What is the equation to calculate dose of parenteral iron in patients with IDA or anemia secondary to blood loss? |
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Definition
IDA: Dose(ml)=0.0442(Desired Hb-Observed Hb) x IBW + (0.26 x IBW)
Patients with Anemia secondary to blood loss:
mg of iron = blood loss x hematocrit |
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