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Pharm 147 Vyas
Terms in this set (40)
Hemoglobin levels in anemia?
<13 g/dL (men) or <8.07 mmol/L
<12 g/dL (females) or <7.45 mmol/L
What is anemia characterized by?
- decrease in Hb or circulating RBCs
- reduced O2 carrying capacity of the blood
- result of decreased RBC production, increased RBC destruction or blood loss
What are the disease states associated w/ normochromic, normocytic anemia?
- recent blood loss
- chronic disease
- renal failure
Which type of anemia (morphology) is associated with sickle cell and thalassemia?
Microcytic, hypochromic anemia
What are the symptoms of anemia?
- decreased exercise tolerance/fatigue/weakness
- chest pain
- neurologic symptoms (Vit B12 deficiency)
What are the signs of anemia?
- pale apperance
- decreased mental acuity
- increased intensity of cardiac valvular murmurs
- diminished vibratory sense or gain abnormality in Vit B12 deficiency
Which anemia is characterized by low MCV, normal serum ferritin, low TIBC?
anemia of chronic disease
Which anemia is characterized by low MCV, low serum ferritin?
iron deficiency anemia
Which anemia is associated with low MCV, normal serum ferritin and high TIBC?
lead intoxication, thalassemia or sideroblastic
Which anemia is characterized by normal MCV and high reticulocyte count?
- acute blood loss
- splenic sequestration
Which anemia is characterized by high MCV, low B12 and normal folate levels?
vitamin b12 deficiency anemia
Which anemia is characterized by high MCV, normal B12 and low folate?
folic acid deficiency
What anemia is characterized by high MCV, and normal B12/folate levels?
- hepatic disease
- drug induce danemia
T/F. Iron deficiency can occur very fast with negative iron balance.
- results from prolonged negative iron balance
- takes time to manifest b/c body has stores of iron used when serum iron levels are low
- iron can also be salvaged from RBC turnover
What are the symptoms of iron deficiency anemia?
- glossal pain
- smooth tongue
- reduced salivary flow
What is the 1st parameter to decrease in iron deficiency anemia?
Normal range for serum ferritin?
15-200 ng/mL (male)
12-150 ng/mL (female)
Serum ferritin levels in IDA?
<15 ng/mL (males)
<12 ng/mL (females)
Which anemia is associated with low TSAT and elevated RDW?
iron deficiency anemia
What is the recommended dose of elemental iron for IDA?
150-200 mg of elemental iron daily in 2-3 divided doses
- if patients cannot tolerate, they may use smaller dose
When should iron be administered?
1 hour before meals b/c food can interfere w/ iron absorption
- may take with food to avoid GI upset
What is the different between ferrous sulfate and ferrous sulfate exsiccated?
- ferrous sulfate contains 20% elemental iron
- ferrous sulfate exsiccated contains 30% elemental iron
What are the 4 oral iro nproduct?
1. ferrous sulfate
2. ferrous sulfate exsiccated
3. ferrous gluconate
4. ferrous fumarate
What are the ADRs of iron administration?
- dark colored stool
- constipation or diarrhea
Which drugs can interfere and decrease iron absorption?
- tetracycline, doxycycline
Which iron preparation is associated with anaphylactic reactions?
- IV iron preparation
What is the result of vitamin b12 or folate deficiency?
- abnormal DNA metabolism
What are causes of non-megaloblastic anemia?
- drugs: hydroxyurea, zidovudine
What is the result of excessive alcohol consumption?
- even with normal levels of B12 and folate and absence of liver disease
What is the role of Vit B12 and folate in the body?
- synthesis of building blocks for DNA and RNA
- maintenance and integrity of neurologic system
- fatty acid biosynthesis & energy production
What are the symptoms of Vit B12 deficiency?
- bilateral parasthesia in extremities
- deficits in proprioception and vibration
What are the symptoms if Vit B12 is not treated?
ataxia, dementia like symptoms, psychosis, vision loss
What are the laboratory findings of Vit B12 deficiency?
- MCV > 100 fL
- macrocytosis + hypersegmented PMNs
- Vit B12 <150-200 pg/mL
What is the oral regimen of Vitamin B12 for Vit B12 deficiency anemia?
1000-2000 mcg Vit B12 QD
What is the IM or deep SQ regimen for Vit B12 deficiency anemia?
1000 mcg (1 mg) QD IM/SQ x 1 week
- then 1 mg every week x 4 weeks
- then 1 mg every month for life (if underlying disorder persists)
When is parenteral therapy for Vit B12 deficiency preferred?
- patients exhibiting neurologic symptoms until resolution of symptoms & normalization of hematologic indices
- when rapid acting therapy is necessary
Which drugs are associated with folic acid deficiency anemia?
- folate antagonists (methotrexate)
T/F. You must rule out Vit B12 deficiency when folate deficiency is suspected.
- this is b/c folate supplements will not reverse the neuorological symptoms of Vit b12 deficiency
What is the difference in lab values b/w folate deficiency anemia & vit b12 deficiency anemia?
in folate deficiency, Vit B12 and methylmalonic acid levels are normal
- Cobalamine levels are low in Vit B12 deficiency (<200 pg/mL)
- MMA is elevated in Vit B12 deficiency
- neuropsychiatric abnormalities are associated more w/ Vit B12
- folate levels are <2 ng/mL in folate defiiency
What is the dosing regimen of folic acid for folic acid deficiency anemia?
1 mg daily to replace stores
*1-5 mg daily for deficiency due to malabsorption
- continue therapy for 4 months
- long term may necessary for chronic conditions
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