Term
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Definition
below normal concentration of Hb in body; Men: Hb <13 mg/dL Females: Hb <12 mg/dL Results in reduction of O2 carrying capacity of blood --> decreased Hb or decreased # of RBCs |
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Term
Consequences of Chronic Anemia |
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Definition
decreased quality of life; decreased survival; increased risk of cardiac complications |
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Term
Vitamin B12 deficiency & folic acid deficiency anemias |
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Definition
macrocytic megaloblastic anemias |
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Term
iron-deficiency anemia, sickle cell anemia, thallassemia |
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Definition
microcytic hypochromic anemias |
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Term
recent blood loss, hemolysis, bone marrow failure, anemia of chronic dx, renal failure anemia |
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Definition
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Term
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Definition
90% produced in kidneys; initiates & stimulates production of RBCs; MoA: prevents apoptosis of erythroid precursor cells to allow for proliferation & subsequent maturation; Decrease in tissue O2 conc. --> increase in production of this & release into plasma |
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Term
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Definition
time it takes for entire process of formation of RBCs from erythroid precursor cells |
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Term
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Definition
normal survival time of RBCs |
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Term
Patient Evaluation of Personal History for Diagnosis |
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Definition
Evaluate pt hx, PhEx/clinical presentation, & Lab tests; Duration of anemia, family hx, social hx, exposure to toxic chemicals, menstrual hx, bowel hx, renal & hepatic dx, diet, previous blood transfusions, peptic ulcers, GI tract malignancies |
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Term
Clinical Presentation of Acute-Onset Anemias |
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Definition
tachycardia (decreased systemic vascular resistance w/ severe intravascular blood loss); lightheadedness; palpitations; angina; hypotension; dyspnea |
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Term
Clinical Presentation of Chronic Anemia |
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Definition
Present after 1-2 months: weakness; fatigue; HA; vertigo; faintness; symptoms of HF; sensitivity to cold; loss of skin tone & pallor; May initially present as asymptomatic |
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Term
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Definition
CBC w/ Hb, Hct, WBC count, & platelets; RBC count & MCV; Peripheral smear; Stool sample for occult blood; |
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Term
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Definition
Males: 14-17.5 g/dL; Females: 12.3-15.3 g/dL; An estimate of O2 carrying capacity of blood. |
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Term
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Definition
Males: 42-50% Females: 36-45%; Decreased Hct --> decrease in # of RBCs or an increase in plasma volume |
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Term
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Definition
50 - 150 mcg/dL; Concetration of iron bound to transferrin; Decreased in IDA & anemia of chronic dx; |
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Term
Total Iron Binding Capacity (TIBC) |
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Definition
250-410 mcg/dL; measures capacity of transferrin to bind to iron; Usually higher when Fe stores are low; |
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Term
Transferrin Saturation (TSAT) |
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Definition
30-50%; = (serum Fe/TIBC) x 100; Reflects extent to which Fe-binding sites are vacant on transferrin & indicates amount of Fe readily available for erythropoeisis; |
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Term
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Definition
<10 - 20 mcg/L; Indicates amount of Fe stored in liver, spleen, and bone marrow cells; Best indicator of Fe deficiency or iron overload; |
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Term
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Definition
Plasma: 3.1-12.4 ng/mL; RBC: 125 - 600 ng/mL; Decreased levels = Folate deficiency megaoloblastic anemia |
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Term
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Definition
180 - 600 pg/mL; Used to determine vitamin B12 deficiency; May be falsely low in folate deficiency, pregnancy, & oral contraceptives use |
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Term
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Definition
increase Hb level: improve RBC O2 carrying capacity, alleviate symptoms, prevent anemia complications |
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Term
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Definition
vital nutrient in development of functioning erythrocytes; essential for formation of hemoglobin |
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Term
Groups at high risk for Iron Deficiency Anemia |
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Definition
children <2 yrs old; adolescent girls; pregnant females; elderly >65 yrs old |
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Term
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Definition
inadequate iron intake (dietary deficiency); when demand > intake (blood donations, endurance sports, menstruation, pregnancy & lactation, infancy & adolescence [growth spurts]); active bleeding/large blood loss; inadequate absorption (drug or food interactions, gastrectomy, malabsorptive states); impaired utilization; |
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Term
Recommended Daily Allowances of of Iron |
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Definition
Males: 8 mg; Postmenopausal Females: 8 mg; Menstruating Females: 18 mg; Children & Pregnant Women require higher amounts: 30 mg/day for primary prevention of IDA; |
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Term
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Definition
Best absorbed in Fe2+ (ferrous) form; Fe3+ is ionized in stomach acid, then reduced to Fe2+ form --> 10-20% absorbed in duodenum & jejunem via intestinal mucosal cell uptake |
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Term
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Definition
amount of iron found in a normal western diet |
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Term
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Definition
decreased serum Fe; decreased serum ferritin; decreased TSAT%; INCREASED TIBC |
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Term
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Definition
decreased Hb; decreased Hct; peripheral smear: microcytosis, hypochromia |
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Term
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Definition
appear when Hb < 9 g/dL: General symptoms - HA, cardiovascular, SOB; glossitis (smooth, sore tongue); reduced salivary flow; pica (compulsive eating of nonfood items); pagophagia (compulsive eating of ice); koilonychia (spoon shape form to fingernails); GI - nausea, anorexia, constipation |
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Term
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Definition
Treat underlying causes - severity & cause determines approach; Replenish Fe stores; Initial Tx: 1) dietary supplementation w/ iron-rich foods; 2) administer oral Fe therapy - 200 mg elemental Fe daily; 3) Parenteral therapy if indicated |
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Term
200 mg elemental iron daily in 2-3 divided doses (maximize tolerability) |
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Definition
recommended oral iron dose for pts with IDA; depends on pt's ability to tolerate iron preparations; tolerance improves w/ small initial dose & gradual escalation to full dose; |
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Term
Recommendations for pts who cannot tolerate recommended oral iron dose (200 mg) |
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Definition
smaller amounts are usually sufficient to replace stores but at a slower rate; take at bedtime; try a different formulation; take with food --> decreases absorption by 50% but decreases GI side effects |
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Term
sodium ferric gluconate (Ferrlecit) |
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Definition
Ferrlicit; NO Black Box Warning; NO test dose required; ADRs: cramps, nausea, vomiting, flushing, hypotension, rash, pruritus, upper gastric pain |
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Term
iron dextran (InFeD, DexFerrum) |
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Definition
InFeD, DexFerrum; For pts w/ DOCUMENTED Fe DEFICIENCY; Black Box Warning: anaphylactic-type rxns - Test dose required; ADRs: pain & brown staining at injection site, flushing, hypotension, fever, chills, myalgia, anaphylaxis; Equation used to determine amt needed: Dose (mL) = 0.0442 (Desired Hb-Observed Hb) x IBW + (0.26xIBW) |
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Term
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Definition
Venofer; NO test dose required; Black-Box Warning: anaphylactic-type rxns; ADRs: leg cramps, hypotension |
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Term
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Definition
Faraheme; NO test dose required; For pts with IDA AND CKD; ADRs: hypotension, dizziness, constipation, nausea, peripheral edema |
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Term
epoetin (Epogen, Procrit) |
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Definition
1st line therapy for Anemia of CKD after ruling out other deficiencies; Starting Dose: SC - 80-120 units/kg/wk divided 2-3x/wk IV - 120-180 units/kg/wk divided 2-3x/wk Half-life = 27 hrs |
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Term
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Definition
1st line therapy for Anemia of CKD after ruling out other deficiencies; INCREASED duration of action; ADV: less frequent dosing; DISADV: longer time period to see effect; Dosing: Starting - 0.45 mcg/kg SC OR IV once weekly; Half-life = 43 hrs --> less frequent dosing, weekly OR every other week; Beneficial in pts in nondialysis CKD & pts who receive peritoneal dialysis; |
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Term
Equation used to determine appropriate dose of parenteral iron (Iron Dextran) in pts w/ IDA or anemia 2ndary to blood loss |
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Definition
Dose (mL) = 0.0442 (Desired Hb-Observed Hb) x IBW + (0.26xIBW) Where Hb is 12 g/dL and dose is in mL, so must multiply by 50mg/mL of iron dextran to obtain mg dose. Remember: iron dextran supplied as 50mg/mL |
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Term
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Definition
ferrous sulfate, ferrous gluconate, ferrous fumarate, polysaccharide iron complex, carbonyl iron |
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Term
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Definition
20% elemental percentage; elemental amount provided: 60-65 mg per 324-325 mg tablet; formulation of choice for treatment of IDA b/c of tolerability, effectiveness, & low cost |
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Term
Adverse Rxns to Oral Iron Products |
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Definition
GI - dark discoloration of feces, CONSTIPATION, abdominal cramping, N/V; -dose related; |
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Term
Response to Oral & Parenteral Iron Therapy |
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Definition
should be seen in 7-10 days; Hb should rise 2-4 g/dL q3 weeks; Reassess if Hb DOES NOT increase by 2 g/dL in 3 wks; Administer 1 hr before or 2 hrs after meals; Addition of ascorbic acid (vitamin C) 500-1000mg may INCREASE Fe absorption by 10% but if taken on empty stomach--> more GI side effects |
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Term
Drugs that Decrease Oral Fe Absorption |
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Definition
Al-, Mg2+, and Ca2+-containing antacids; tetracycline, doxycycline; H2-antagonists; PPIs; Cholestyramine; caffeine |
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Term
Drugs Affected by Oral Iron |
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Definition
decreased L-dopa; decreased methyldopa; decreased levothyroxine; decreased penicillamine; decreased fluoroquinolones; decreased tetracycline & doxycycline; decreased mycophenolate |
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Term
Counseling Pts for Oral Iron Therapy |
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Definition
Keep out of reach of children; Take on an empty stomach - at least 1 hr before meals; Take 2 hrs before or after antacids, PPIs, and H2-antagonists, Ca supplements, fluoroquinolones, & tetracyclines; Combine with stool softener or laxative to prevent constipation; Liquid preparations --> teeth discoloration, can mix w/ fruit juice or milk, drink with straw; |
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Term
Common causes of Tx Failure in pts taking Oral Fe Therapy |
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Definition
poor pt adherence; inability to absorb Fe; incorrect diagnosis; continued bleeding; concurrent condition that impairs full reticulocyte response |
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Term
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Definition
amount of time oral treatment for IDA should be continued after anemia is resolved --> allows for repletion of Fe stores to prevent relapse |
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Term
Indications for Parenteral Fe Therapy |
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Definition
evidence of iron malabsorption; intolerance to oral administration; Long-term nonadherence suspected; pts w/ significant blood loss who refuse transfusions; |
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Term
NO, parenteral does not provide a quicker hematological response than oral Fe therapy |
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Definition
Does parenteral iron lead to a quicker hematological response than oral iron? |
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Term
vitamin B12 deficiency anemia |
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Definition
before treating folic acid deficiency anemia, this anemia MUST be ruled out |
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Term
Etiology of Vitamin B12 Deficiency Anemia |
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Definition
inadequate intake (RARE) - diet is only source; decreased absorption - pernicious anemia (lack of intrinsic factor 2ndary to immune destruction of gastric mucosa); inadequate utilization - transcobalamin II deficiency, renal glomerular dx, liver dx; HYPERutilization - hyperthyroidism, pregnancy; |
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Term
Physical Findings of Vitamin B12 Deficiency Anemia |
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Definition
glossitis; dysphagia; anorexia/weight loss; beefy red tongues; |
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Term
Neurologic Findings of Vitamin B12 Deficiency Anemia |
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Definition
numbness; paresthesias; peripheral neuropathy; ataxia; diminished vibratory sense; increased deep tendon reflexes; decreased proprioception; imbalance |
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Term
Psychiatric Findings of Vitamin B12 Deficiency Anemia |
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Definition
irritability; personality changes; memory impairment; dementia; depression; psychosis (rare) |
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Term
Lab Value Findings for Vitamin B12 Deficiency Anemia |
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Definition
decreased Hct; INCREASED MCV; INCREASED MCH; decreased reticulocyte count; decreased Vit. B12 level; INCREASED iron & TSAT% |
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Term
Peripheral Blood Smear for Vitamin B12 Deficiency Anemia |
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Definition
macrocytosis; hypersegmented polymorphonuclear leukocytes; oval macrocytes; anisocytosis; poikilocytosis; |
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Term
Goals of Tx for Vit. B12 Def. Anemia |
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Definition
reversal of hematologic manifestations; replacement of body stores; prevention or resolution of neurological manifestations; |
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Term
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Definition
Take 1-2 mg PO daily x 1-2 wks then 1 mg daily; As effective as IM therapy in achieving hematological & neurological response; AVOID time-released preps; OTC is available; |
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Term
Parenteral cyanocobalamin (IM) |
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Definition
Initial: 1000 mcg/day x 2 wks, then 1000 mcg/wk until Hb WNL; Maintenance: 1000 mcg/month; Preferred route for pts exhibiting neurological symptoms; |
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Term
Intranasal gell cyanacobalamin |
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Definition
Inhale 500 mcg/wk (1 spray/wk); AVOID in pts receiving meds intranasally in same nostril; AVOID administering 1 hr before or after ingestion of hot foods or beverages; ADV: pts who are homebound, have cognitive impairment, or dysphagia; DISADV: efficacy not well studied, ONLY USED FOR MAINTENANCE therapy; |
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Term
Adverse Events from Cyanacobalamin (RARE) |
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Definition
RARE - hyperuricemia, hypokalemia, injection site pain, pruritus, rash, diarrhea; |
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Term
Monitoring Parameters for Tx w/ cyanacobalamin for Vit. B12 Deficiency Anemia |
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Definition
1) neurologic symptoms - improvement in 24 hrs, may not completely resolve; 2) CBC improvement - Hb & Hct normalize within 6-8 wks, reticulocyte count INCREASES within 3-4 days, Check CBC every 3-6 months |
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Term
Etiology of Folic Acid Deficiency Anemia |
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Definition
1) inadequate intake - poor eating habits (elderly, teenagers, alcoholics, food faddists, low socioeconomic class); 2) malabsorptive syndromes; 3) medication use (drugs that directly inhibit DNA synthesis [azathioprine, 6-mercaptopurine, 5-fluorouracil, hydroxyurea, zidovudine] & drugs that are folate antagonists - methotrexate, pentamidine, trimethoprim, primidone); 4) inadequate utilization; 5) hyperutilization - pregnancy, chronic inflammatory dxs, long-term dialysis, burn pts, growth spurts; |
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Term
Lab Value Changes in Folic Acid Deficiency Anemia |
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Definition
decreased Hct; INCREASED MCV; INCREASED MCH; decreased reticulocyte count; DECREASED folic acid level; DECREASED erythrocyte folic acid level; increased serum iron & TSAT%; |
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Term
Goals for Treatment of Folic Acid Deficiency Anemia |
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Definition
induce hematologic remission; replace body stores; resolve signs & symptoms; treat underlying disorder; increase dietary intake; |
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Term
Replacement Dosing for Folic Acid Deficiency Anemia |
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Definition
1 mg daily x 4 months; may continue if risk factors for deficiency are still present; |
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Term
Maintenance Dosing for Folic Acid Deficiency Anemia |
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Definition
0.1-0.4 mg daily - up to 0.8 mg for pregnant/lactating women (initial prevention: 0.4 mg/day) |
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Term
Adverse Effects of Folic Acid Supplementation |
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Definition
bitter/bad taste; GI upset - nausea, flatulence, anorexia; nontoxic at high doses --> rapidly excreted in urine |
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Term
Monitoring Parameters for Treatment of Folic Acid Deficiency Anemia |
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Definition
CBC - MCV initially increases because of increases in reticulocytes |
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Term
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Definition
a common form found particularly in elderly; results from: Chronic inflammation - TB, HIV, bacterial endocarditis, osteomyelitis, chronic UTIs; Chronic Inflammation - RA, SLE, IBD, IOA, gout, etc.; Malignancies - carcinoma, lymphoma, leukemia, multiple myeloma |
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Term
Lab Values for Anemia w/ Chronic Dx |
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Definition
decreased iron; decreased or WNL transferrin; decreased TSAT%; INCREASED or WNL serum ferritin; WNL soluble transferrin receptor; DECREASED or WNL TIBC; |
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Term
Treatment Goals for Anemia of Chronic Dx |
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Definition
Aimed at underlying pathology; RBC transfusions reserved for Hb <8-10 g/dL; Use erythropoeitin and iron supplementation in proper pts; |
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Term
Indications for Erythropoeitin Use in pts w/ Anemia of Chronic Dx |
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Definition
cancer receiving chemotherapy; chronic kidney dx; HIV pts receiving myelosuppressive therapy |
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Term
Indications for Iron Supplementation in pts w/ Anemia of Chronic Dx |
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Definition
iron deficiency; pts receiving erythropoietic agents |
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Term
Anemia of Chronic Kidney Dx |
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Definition
common form of anemia in these pts; normocytic, normochromic anemia; Factors responsible: DECREASED ERYTHROPOIETIN PRODUCTION, shorter life span of RBCs, blood loss during dialysis, Fe deficiency, ACD, renal osteodystrophy |
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Term
Initiate in pts w/ Stage III CKD or higher: GFR <60 ml/min, Hb conc. <11 g/dL |
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Definition
When should one start anemia evaluation & treatment for pts with chronic kidney disease? |
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Term
Target Hb Level for Pts w/ Anemia of CKD |
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Definition
Hb >11-12 g/dL - NOTHING HIGHER THAN 12 g/dL!!!; Hb >12 --> INCREASED cardiovascular events |
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Term
Adverse Events with Erythropoeitin agents |
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Definition
HYPERTENSION (most common); seizures, thrombotic events, allergic rxns |
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Term
Monitoring of Outcomes for Erythropoiesis Stimulating Agents - epoietin, darbapoietin |
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Definition
Hb monitored every 1-2 wk, then every 2-4 wks when stable; DO NOT change dose upwards more than every 4 wks; Make adjustments in 25% intervals based on Hb levels; Target Hb levels: 11-12 g/dL; Withhold therapy if Hb >12 g/dL; Pts who do not respond to therapy after 8 wks of optimal dosage should D/C |
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Term
Common Causes of Indequate Response to ESA Therapy |
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Definition
IRON DEFICIENCY (most common), infection/inflammation, chronic blood loss, osteitis fibrosa, aluminum toxicity, hemoglobinemias, folate or B12 deficiency, multiple myeloma, malnutrition, hemolysis, vit. C deficiency hypothyroidism |
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Term
Provide Iron Supplementation in Pts w/ Anemia of CKD |
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Definition
check baseline iron before & during ESA treatment; Most pts REQUIRE supplemental therapy; Maintain Stores at: TSAT >20%, serum ferritin >100 ng/mL (pts NOT receiving hemodialysis), serum ferritin >200 ng/mL (hemodialysis pts);
if BELOW goal indices --> recommend supplementation |
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Term
IV Iron therapy recommended |
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Definition
For pts with Anemia of CKD, use this form of iron therapy |
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Term
Indications for Oral Iron Therapy |
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Definition
Pts w/ Anemia of CKD who DO NOT have IV access: Pts w/ Stage III & IV CKD, receiving peritoneal dialysis, switch to IV if unable to manage |
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Term
Evaluation of Therapeutic Outcomes w/ Iron Therapy |
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Definition
for pts receiving ESA therapy, monitor Fe stores: monthly in pts NOT receiving iron supplements, EVEY 3 MONTHS in pts WHO ARE receiving Fe supplements; When goal Hb is met (11-12 g/dL), monitor stores EVERY 3 MONTHS |
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