Anemias

IDA specific s/sx

glossitis

koilonychia

pica

B12 def. anemia specific s/sx

peripheral neuropathies

visual disturbances

psych sx

mechanisms that cause anemia

blood loss

hemolysis

reduced erythropoiesis

causes of IDA

diet

blood loss

decreased iron absorption due to high stomach pH

increased bodily requirements

iron supplements

oral iron - acidic conditions (take on empty stomach/vit C)

ferrous sulfate

avoid taking with antacids/high Ca2+ foods

black/green stools, itching, arthralgia

B12 def.

absence leads to impaired DNA synthesis → erythrocyte apoptosis

caused by poor absorption (small intestine disorders), drugs interfering with absorbance, alcohol use

s/sx folic acid def. anemia

atrophic glossitis (smooth tongue)

changes to hair, skin, fingernail pigmentation

macrocytic anemias management

oral tablets - incomplete absorption likely, other drugs may interfere and decrease absorption, larger doses required

IM injections - immediate onset, routine

ACD cause

EPO deficiency due to proinflamm. cytokines that decrease its production, blunting erythroid marrow response to EPO → more EPO required

ACD management

iron supplements, ESAs (epoetin alfa, darbepoetin alfa) for management of anemia with CKD/HIV/chemo

erythropoietin-stimulating agents (ESAs)

epoetin alfa - human EPO

darbepoetin - Chinese hamster ovary cells (nearly identical to human EPO)

risk of death from thrombosis, HTN, DVT/PE, CVA, MI

aplastic anemia cause and risk factors

damage to or defective bone marrow

congenital or acquired

risk of infection/bleeding

aplastic anemia management

marrow transplant

immunosuppressants

blood transfusion

sideroblastic anemia causes

abnormal use of iron during erythropoiesis

circulating iron levels nml/elevated

congenital/acquired forms - presence of ringed sideroblasts

sideroblastic anemia s/sx

basic anemia sx

sideroblastic anemia management

relies on cause

B6, metal chelators (subcut./IM deferoxamine, oral deferasirox)

hemolytic anemia causes

RBCs are destroyed faster than nml lifespan

thalassemia, sickle cell disease, autoimmune conditions, infections can be meds-induced

hemolytic anemia s/sx

fatigue, weakness, hepatosplenomegaly, jaundice, dark urine

hemolytic anemia management

folic acid, corticosteroids (autoimmune), rituximab injection, IVIG

sickle cell anemia causes

mutation in beta-globin gene

abnormally shaped Hb - HbS - with reduced O2 binding capacity, rigid RBCs with shorter lifespan because of premature destruction

autosomal recessive (parents are carriers)

sickle cell manifestation

chronic hemolytic anemia - jaundice, fatigue, etc

periodic episodes of extreme pain (vaso-occlusive) - swelling in hands and feet

risk of infection - functional asplenia

sickle cell treatment

1st line - hydroxyurea

• increased HbF which interferes with HbS polymerization

• reduces sickling → less pain episodes