Pharm Week 14 anemia

Anemia S&S

fatigue, pallor, dyspnea, changes in texture and color of nails, low HgB

Anemia underlying causes

iron deficiency, vitamin B12/folate deficiency, RBC destruction

Anemia etiology

bleeding or insufficient nutrition, failure of stomach lining to produce intrinsic factor, poor diet (alcohol use disorder), or intestinal malabsorption, blood transfusion reaction, sickle cell

Anemia pathophysiology

insufficient Hgb synthesis, RBC maturation issues (megaloblastic), RBC destruction

Anemia treatment

Iron supplements for iron deficiency, B12 (cyanocobalamin) for pernicious, Folic acid (B9) for folic acid deficiency, or treat underlying cause

Anemia pharmacotherapy

Erythropoiesis-stimulating agents (ESAs), supplements (iron, B12, folate)

Acute anemia interventions

blood administrations & transfusion reaction monitoring

Blood administration protocol

pre-medication, rate control, vital signs monitoring

Transfusion reaction management

stop infusion, notify HCP, manage symptoms (fever, urticaria, hemolysis)

Pre-transfusion checklist

verify informed consent, triple check expiration time and blood type match, two-RN verification

Blood administration guidelines

use special blood tubing with a filter, use 19g or larger catheter, administer over >1 hr but <4 hr, anticipate premedications (acetaminophen/diphenhydramine) if history of reactions, send blood back to blood bank if cannot be immediately transfused

Post-procedure protocol

monitor parameters, draw post-transfusion CBC (Hgb, PLT, coagulation studies, fibrinogen), educate pt. on S&S to report

Transfusion allergic reaction

Mild triggers: facial flushing, hives/rash

Severe triggers: increased anxiety, wheezing

Vitals: decreased BP

Febrile transfusion reaction

Fever, feeling colder than normal (w/out chills), headache, anxiety

Vitals: tachycardia, tachypnea, slight increase in BP

Hemolytic transfusion reaction

Chest pain, apprehension, low back pain, chills

Distinctive cues: hemoglobinuria

Vitals: decreased BP, increased RR, tachycardia

Anemia dietary modifications

iron-rich foods, vitamin B12/folate sources, Folic acid (B9), vitamin C (catalyst)

Iron sources

meats, seafood, dark leafy greens, whole grains, fortified cereals, bran, beans, nuts

Folic acid sources

fortified cereals/grains, legumes, oranges, greens

Pernicious anemia patho

1. Gastric pits produce intrinsic factor

2. Vitamin B12 enters the stomach but cannot be absorbed alone

3. Intrinsic factor binds to B12

4. The combined B12 & intrinsic factor complex successfully unlocks the intestinal wall and is absorbed into the bloodstream

Without intrinsic factor, PO B12 simply passes through the body unabsorbed

Iron mechanism

carries oxygen

for iron deficiency or blood loss after PRBCs

Route: PO, IV, IM, SQ

Iron adverse effects

PO causes GI upset, black stools

IV causes hypotension

Vitamin B12 (Cyanocobalamin) mechanism

used for pernicious anemia

activates folic acid

Folic acid (B9) mechanism

needed to develop erythrocytes

used for folic acid deficiency (alcohol abuse), early pregnancy (prevents neural tube defects)

Routes: PO, IM

Folic acid adverse effects

rare, but may turn urine yellow

Iron administration

Keep pt. upright for 30 minutes after PO admin to prevent GI irritation

Liquid iron may stain teeth, always use straw, do not crush iron tablets

Always use Z-track method for IM injections to prevent skin staining & irritation

Run IV with NS

IV iron sucrose (Venofer) SE

high risk for hypotensive and anaphylactic reactions

Epoetin alfa (Epogen)

erythropoiesis-stimulating agents (ESA)

Epoetin alfa (Epogen) mechanism & indications

Mechanism: promotes the synthesis of erythrocytes (RBCs)

Indications: used for pts. with low RBCs due to chronic renal failure, chemotherapy, or HIV pts. receiving antiviral zidovudine

Epoetin alfa (Epogen) route

SQ, IV (given w/dialysis for CRF)

Epoetin alfa (Epogen) consideration

most patients receiving epoetin alfa must also receive an oral or IV iron preparation concurrently to support new RBC production

Hold if pt. has uncontrolled hypotension or if HgB >10 (for cancer pts.)/>11 (for renal pts.)- risk of MI or CVA