PART 2: Anemia Hematopoetic Growth Factor

True

Iron preparations are used only for the treatment or prevention of iron deficiency anemia.

Hypochromic

Microcytic

Lab Indicators

Name the 3 Characteristics of Anemia

Hypochromic

Low hemoglobin content in red blood cells

Microcytic

Smaller-than-normal red blood cells

Lab Indicators

Low mean cell volume (MCV) and mean cell hemoglobin concentration

Iron deficiency

What is the leading cause of chronic anemia

pallor

fatigue

dizziness

exertional

dyspnea, all related to tissue hypoxia

Symptoms of Iron deficiency

True

Cardiovascular adaptations (like tachycardia, increased cardiac output, vasodilation) may worsen with an underlying cardiovascular disease

Iron Deficiency

Microcytic hypochromic with MCV < 80 fL and MCHC < 30%

Folic Acid Deficiency

Macrocytic, normochromic with MCV > 100 fL and normal or elevated MCHC

Vitamin B12

Macrocytic, normochromic with MCV > 100 fL and normal or elevated MCHC

"PICC"

Pregnant and Lactating Women

Infants

Children

CKD Patients

Populations at Risk for Iron Deficiency (4)

Iron

Premature infants have increased _____ needs

Rapid growth phase! (Esp young boys)

Children are at risk for Iron Deficiency during what phase?

CKD Patients

High erythrocyte turnoverdue to hemodialysis and erythropoietin treatment

Increased Iron Requirements

Inadequate Absorption

Blood Loss (Mensruation, GIT)

Causes of Iron Deficiency

True

Growth and physiological states like pregnancy has increased iron requirements

Gastrectomy or severe small bowel disease

This disease leads to malabsorption of iron

30mg of iron per menstrual cycle, more with heavy bleeding

What is the amount of iron women lose during menstruation?

GIT

What is the most common site of blood loss in men and postmenopausal women?

Oral Iron Therapy

Parenteral Iron Therapy

Iron Deficiency Anemia Treatment (2)

Oral Iron Therapy

What is the preferred method and the first choice for correcting anemia when gastrointestinal absorption is normal

Ferrous salts (e.g., ferrous sulfate, ferrous gluconate, ferrous fumarate)

What salts are preferred for their efficient absorption and cost-effectiveness

200-400 mg

____ - ____ mg of elemental iron daily is recommended, with lowerdoses if side effects occur

False, 3-6 months only

Continue therapy for 6-12 months after correcting the cause of iron loss to replenish iron stores (T/F)

Ferrous sulfate hydrated

Tablet size: 325 mg

Elemental Iron per Tablet: 65 mg

Usual Adult Dosage: 2-4 tablets per day

Ferrous sulfate dessicated

Tablet size: 200 mg

Elemental Iron per Tablet: 65 mg

Usual Adult Dosage: 2-4 tablets per day

Ferrous gluconate

Tablet size: 325 mg

Elemental Iron per Tablet: 36 mg

Usual Adult Dosage: 3-4 tablets per day

Ferrous fumarate

Tablet size: 325 mg

Elemental Iron per Tablet: 106 mg

Usual Adult Dosage: 2-3 tablets per day

"ABCD, N"

abdominal discomfort

black stools

constipation

diarrhea

nausea

Common adverse effects of Oral Iron Therapy

Parenteral Iron Therapy

This type of therapy is reserved for patients who cannot tolerate or absorb oral iron, and those with chronic anemia (e.g., chronickidney disease patients on hemodialysis)

Free ferric iron

A parenteral iron that can cause serious toxicity

Administer iron as a colloid with a carbohydrate coating to release iron slowly

How to mitigate toxicity in free ferric iron?

Iron Dextran

Sodium Ferric Gluconate & Iron-Sucrose Complex

Ferric Carboxymaltose & Ferumoxytol:

Forms of Parenteral Iron (3)

Iron Dextran

Can be given intramuscularly or intravenously, with intravenous administration being preferred

headache

fever

nausea

rarely, anaphylaxis

Adverse effects of Iron dextran include

True

A test dose is recommended to check for hypersensitivity to Iron dextran

Sodium Ferric Gluconate & Iron-Sucrose Complex

What is the alternative options for parenteral iron therapy with fewer severe reactions

Ferric Carboxymaltose & Ferumoxytol

Newer preparations with specific considerations, such as ferumoxytol, potentially interfere with MRI studies.

Ferumoxytol

The FDA has issued warnings about severe allergicreactions with _________

Young

10

Acute Iron Toxicity usually occur in ________ children who accidentally ingest iron tablets. As few as __tablets can be lethal

Necrotizing gastroenteritis

Vomiting

Abdominal pain

Bloody diarrhea

Early Signs of Acute Iron Toxicity

shock

lethargy

dyspnea

metabolic acidosis

coma

death

Severe symptoms in acute iron toxicity may follow, such as (6)

Immediate Action

Whole bowel irrigation to remove unabsorbed pills

Iron Chelation

Intravenous deferoxamine is used to bind and promote the excretion of absorbed iron.

False, ineffective

Activated charcoal is effective as it does not bind iron (T/F)

Supportive Care

Treatment for gastrointestinal bleeding, metabolic acidosis, and shock is essential.

Iron Overload

Chronic Iron Toxicity is also known as

Inherited Hemochromatosis

Frequent Blood Transfusions

Iron Overload Causes (2)

Inherited Hemochromatosis

Excessive iron absorption due to a genetic disorder

Frequent Blood Transfusions

Often seen in patients with conditions like β-thalassemia

Excess iron deposits in organs such as the heart, liver, and pancreas can lead to organ failure and death

Consequences of Iron Overload

Phlebotomy

Iron Chelation Therapy

Chronic Iron Toxicity Treatment (2)

Phlebotomy

The most efficient treatment when anemia is not present; one unit of blood is removed weekly until excess iron is depleted.

Parenteral deferoxamine

Oral chelators deferasirox and deferiprone

Medications in Iron Chelation Therapy

Agranulocytosis with deferiprone

Chelation therapy is less efficient, more complex,expensive, and carries risks, such as

CBC monitoring

Regular _________________is required for patients on deferiprone to detect potential side effects

Cobalamin

Vitamin B12

Vitamin B12 (cobalamin)

A cofactor for essential biochemical reactions in the body

Megaloblastic Anemia

Gastrointestinal Symptoms

Neurologic Abnormalities

Vitamin B12 Deficiency Effects (3)

Megaloblastic Anemia

Large, immature red blood cells

Gastrointestinal Symptoms

Digestive issues

Neurologic Abnormalities

Nerve damage and related symptoms

Dietary Deficiency

Absorption Issues

Causes of Vitamin B12 Deficiency (2)

Dietary Deficiency

Rare cause, but it can occur in strict vegetarians

Absorption Issues

Common cause in older adults is due to inadequate absorption, rather than dietary insufficiency.

porphyrin-like ring

The strcuture of Vitamin B12 has a ______ ring with a central cobalt atom forming different cobalamins

Deoxyadenosylcobalamin

Methylcobalamin

Active forms of cobalamin (2)

Cyanocobalamin

Hydroxocobalamin

Therapeutic Forms of Cobalamin (2)

Microbial Synthesis

Intrinsic Factor

Sources of Cobalamins (2)

Microbial Synthesis

Not produced by animals or plants, but obtained from microbially derived sources in meat, eggs, and dairy

Intrinsic Factor

A stomach protein required for B12 absorption, differentiating it from the "extrinsic factor" (dietary B12)

5-30 mcg

The average diet provides _ - ___ mcg of B12, with 1-5 mcg absorbed.

False, in the LIVER

Vitamin B12 is stored in the pancreas, with a total body pool of 3000-5000 mcg (T/F)

False, 2 mcg only

About 20 mcg is needed daily, and deficiency symptoms can take years to develop if absorption ceases (T/F)

Stomach

Distal ileum

Receptor-mediated

B12 binds to intrinsic factor in the _____ and is absorbed in the __________ through a ________________ process

Most commonly due to malabsorption, either froma lack of intrinsic factor or issues in the distal ileum

Deficiency Causes

Gycoproteins (transcobalamins I,II, and III)

B12 is carried to cells by

Liver

Excess B12 is stored in the