FOLLEN- EXAM 1

What are the general signs of anemia?

• decreased exercise tolerance

• dizzy, weak, fatigue

• irritability

• palpitations, chest pains, SOB

• vertigo

• neurological symptoms

What are the general symptoms of anemia?

• tachycardia

• pale

• impaired cognitive functions

What is the most common cause of microcytic anemia?

iron deficiency

What is the most common cause of macrocytic anemia?

• vitamin b-12 deficiency

• folate deficiency

Which anemia is most likely to cause irreversible neurological complications?

vitamin b-12

What lab findings would you expect to see in iron deficiency anemia?

• low Hgb

• low reticulocytes

• low MCV

• low serum iron and ferritin

• low TSAT

• High TIBC

Which of the following are manifestations specific to severe iron deficiency anemia?

a. pica

b. neurologic findings (numbness and paraesthesias)

c. vision changes

d. psychiatric findings

a

Which of the following is the best indicator of iron deficiency or iron overload?

a. serum iron

b. ferritin levels

c. transferrin saturation (TSAT)

d. total iron-binding capacity (TIBC)

b

What are the treatment options available for iron deficiency anemia? How much elemental iron does each oral option include? How many mg would be in 325mg tab?

• tx includes diet changes and oral supplements

For a 325mg tab:

• Ferrous sulfate- 20% elemental iron- 65mg

• Ferrous gluconate- 12% elemental iron- 38mg

• Ferrous fumarate- 33% elemental iron- 106mg

Iron supplements should be taken _______ or _____________.

daily or every other day

A patient takes a ferrous sulfate 325 mg tablet PO TID to treat her iron deficiency anemia.  How much elemental iron is she taking per day?

195 mg

What is the antidote for iron overdose?

deferoxamine

What are the major side effects associated with oral iron administration?

GI—> constipation, dark stools, nausea, upset stomach

What are counseling points for oral iron therapy administration?

• vitamin C can increase iron absorption

• take 1 hr before/2 hr after meals

  • exception: if GI upset—> take with food

What is the most common cause of Vitamin B12 deficiency?

pernicious anemia (an autoimmune condition)

What laboratory findings would you expect to see in vitamin B12 deficiency anemia?

• low Hgb

• low reticulocytes

• low B-12

• HIGH MCV

• elevated methylmalonic acid and homocysteine

What is the treatment for vitamin B12 deficiency anemia?

• foods high in vit b-12

• oral vitamin b-12 (rx dose is usually between 1000-2000mcg)

What laboratory findings would you expect to see in folic acid deficiency anemia?

• low Hgb

• low reticulocytes

• low folic acid

• HIGH MCV

• elevated homocysteine

What is the treatment for folic acid deficiency anemia?

• eat foods high in folic acid

• oral supplements (usually 1-5mg)

What is recommended for all pregnant women to decrease megaloblastic anemia/neural tube defects?

folic acid

What biochemical defect leads to the development of HbS?

B6: E—> V or Glutamate—> Valine

What biochemical defect leads to the development of HbC? 

B6: E—> K or Glutamate—> Lysine

What are potential ACUTE complications of SCD? (just recognize, do not memorize)

• Acute chest syndrome

• Anemia

• Cholecystitis

• Infection

• Multiorgan failure

• Priapism (painful/long erection)

• Splenic sequestration

• Stroke

• Vaso-occlusive crisis

What are potential CHRONIC complications of SCD? (just recognize, do not memorize)

• Avascular necrosis

• Depression and stress

• Gallstones

• Leg ulcers

• Pain

• Pregnancy complications

• Pulmonary HTN

• Recurrent priapism

• Renal impairment

• retinopathy

What immunizations are recommended for patients with SCD?

• influenza

• pneumococcal

• meningococcal

• haemophilus influenza (Hib)

When is prophylaxis with oral penicillin V potassium recommended for SCD?

• INFANTS who screen positive for SCD at birth should be initiated on twice daily penicillin and treated until AGE 5 YEARS

  • Should continue indefinitely if pt. undergoes surgical removal of spleen or develops infection

What SCD treatment option stimulates fetal hemoglobin production?

Hydroxyurea

What are the boxed warnings and warnings for Hydroxyurea?

• BBW: myelosuppression

• warnings: FETAL TOXICITY, avoid live vaccines

What are the most common side effects of glutamine treatment?

GI—> constipation, abdominal pain, nausea

What is the primary indication for chronic transfusions in SCD?

stroke prevention AND to lessen the severity of organ damage

What are the risks associated with chronic transfusions in the management of SCD?

• Alloimmunization

• Hyperviscosity

• Transfusion transmitted viral infections

• Volume or iron overload

• Nonhemolytic transfusion reactions

Which SCD treatment options are considered gene therapies?

• Lyfgenia (lovo-cel)

• Casgevy (exa-cel)

Which treatment option can cure patients with SCD?

Allogeneic hematopoietic stem cell transplantation (HSCT)