the iron curtain

must add teh generic/brand for supplemtns

normal Hgb in men

13.5-17.5 g/dL

normal Hgb in women

12-16 g/dL

what is severe low Hgb

8 g/dL

range for mean corpuscular volume

50-150 microgram/dL

acute symptoms of anemia

tachycardia, hypotension, palpitations, angina, lightheadness

chronic symptoms of anemia

fatigue, weakness, dyspnea, vertigo, pallor, sensitivity to cold

what are the microcytic anemias

• iron deficiency

• from chronic disease

• sideroblastic aneimia

cannot make enough hemoglobin

what are the macrocytic anemias

• folate deficiency, vitamin B12 def

• liver disease, alcoholism, drugs

impaired DNA synthesis

what causes like normocytic anemias

chronic kidney disease (per bennett), apparent lack of like blood materials ie from blood loss, inflamamtion

what kind of def is iron def anemia

microcytic

what can cause iron def anemia

inadequate intake— vegetarian, psychosis apparently lol

blood loss— GI hemorrhage, heavy menses, drug inducsed (nsaids, steriods, antiplt)

reasons for decreased iron absorption (ppi, ibd) or increased FE requirement (preg, lact, infants/children)

what can decrease Fe absorption

taking PPI, Celiac disease, IBD, gastric bypass

• celiac disease— damages the small-intestinal lining— autoimmune disease attacking gluten

what increases Fe requirement

pregnancy, lactation, infants, during rapid growth in children and adolescents

what is first line for iron-def? esp in preg anemic pts

oral iron

adr of oral iron

constip, dark/tarry stool, GI upset

BBW of oral iron

accidental overdose of iron, fatal poisoning in children

what is antidote

top vitamin def associated with macrocytic anemia

vit b9 and b12

what is blood composition

• rbcs — erythrocyte— second most

• plasma— most of composition

• wbcs

  • plts

what are the eytrhocytes (ESA)

Hgb (hemoglobin)

hemocrit/MCV are measurements

what is hematocrit

Percentage of blood volume occupied by RBCs

• 
  

how long RBCs last

3 months

how long WBCs last

6-12 hours

what does anemia refer to

RBCs only!

what is MCV

mean corpuscular volume

• Average size of one RBC

do RBCs have nuclei

NOOOO they are werid

antidote for Fe acute poisoning

deferoxamine

deferoxamine CI

anuria

antidote for chronic Fe overload

oral deferasirox

deferasirox bbw

renal failure, GI hemorrahge, hep failure

deferasirox serious ad eff

GI perforation, SJS/ten

deferasirox CI

advanced malignancies

what does low MCV mean

microcytic anemia!

what is neutropenia

decreased neutrophils— the majority of WBCs

• means infection, cancer

what is thrombocytopenia

too few platelets

• need the anticoags

  • often a problem with factors 8 and 9

what do you use with Fe IV (transfusion) overload

deferiprone (oral)

deferiprone BBW

agranulocytosis/neutropenia

what is the mg of elemental iron in Fe-sulfate

65 (325 mg)

mg of elemental iron in Fe sulfate ER

50 (160 mg)

what is erythropoietin

a hormone produced mainly by the kidneys that tells the bone marrow to make more red blood cells

how do antacids effect Fe absorb

decrease — Fe 2 before or 4 hr after

• chelatin’

how do H2RA/PPIs effect Fe absorb

decrease— spacing doesnt help

• NOT chelating i daresay

how does Vitamin C effect Fe absorb

increases— helps to take together

how does Quinolone, tetracycline, cefdinir affect Fe absorb

nothing— but iron decreases THEIR absorption

• 2 hr before or 4-8 hr after

(fluroquinolones, tetracyclines)

how do bisphosphonates affect Fe absorb

nothinggg but iron decreases their absorption

• Alendronate, Risedronate

normal ranges for HCT

three times Hgb— 36-45 ish

normal ranges for MCV

three times the Hct (which is three times the Hgb)

so like 80-100 ish

Levothyroxine, levodopa, methyldopa how Fe affect

decreases absorption

• Fe 2 hr before or 4 hour after

what are some forms of IV iron

• iron sucrose

• Ferumoxytol

• Iron dextran complex (INFeD)

think if its iron with an absorbable sugar its IV!

when would use IV iron

CKD on hemodialysis, CKD receiving ESA, unable to tolerate oral iron, loosing iron too fast, severe anemia

what are the WBCS

lymphocytes, basophils, eosinophils, monocytes, neutrophils

when you are infected what lab value elevated

WBCs!

what is ESA

erythropoiesis-stimulating agent— when not making enough RBCs.

• need iron to be able to make more RBCs

BBW for IV iron

Fatal anaphylaxis rxn

what is BBW for Ferumoxytol specifically (a kind of IV iron)

angioedema, loss of consciousness

why does IV iron have to be given slowly? what are other side effects

risk of hypotension

• chest pain

what chains does the hemoglobin protein normally contain

2 alpha chains; 2 beta chains

pathophys of b-thalassemia

genetic disorder where body can’t make beta chains of hemoglobin protein

• less RBCs in general— cant make it out of the bone marrow

  • the RBCs that survive be smol and deformed womp

what is the drug to treat B-thalassemia

reblozyl (luspatercept-aamt)

how does reblozyl work (luspatercept-aamt)

it is a protein

binds to TGF-beta cells to stop Smad signalling t

• Smad signalling keeps the deformed cells from maturing

allows cells to keep growing (late stage development)

what besides b-thalassemia can reblozyl treat

myelodysplastic syndrome (MDS)

• also just helps with late stage development of otherwise deformed cells

ADR of reblozyl for b-thalassemia

HTN

what is highest Fe elemental mg form

Fe-fumarate

how much Fe in Fe-fumarate

106

what is lowest Fe pill mg

Fe-gluconate

what does the whole 65 (325) Fe-sulfate mean

there is only 65 mg in Fe

what is “mush and push” again

bisacodyl l o l

why does kidney disease affect RBCs

kidney releases erythropoietin that stimulates bone marrow to produce RBCs

what are the steps in normocytic anemia treatment

1. iron therapy

2. ESA/EPO (erythropoiesis stimulating agent, erythropoietin)

3. HIF-PHI

what are HIF-PHIs

oral drugs in class called hypoxia-inducible factor–prolyl hydroxylase inhibitor

• make body think it is low oxygen to produce more EPO and so produce more heme/RBCs

how does Epoetin and Darbepoetin work

induce erythropoiesis by stimulating the division and differentiation of erythroid progenitor cells, induce release of reticulocytes from the bone marrow into bloodstream to become mature erythrocytes →

increase Hct and increase Hgb level

brands for epoetin alpha

epogen, procrit

darbepoetin brand

aranesp

darbepoetin alpha (aranesp) how does t0.5 compare to epogen

2-3 times the half life

• and t0.5 of epoetin alpha is 4-13 so do the math ya brainaic

ADRs of epoetin, darbepoetin alpha

edema, fever, HA, insomnia, arthalgia

examples of ESAs

Epoetin alpha, Darbepoetin alpha

CI of ESAs like Epoetin alpha, Darbepoetin alpha

uncontrolled HTN

BBW for Epoetin alpha, Darbepoetin alpha

stroke, MI, worsening CHF and HTn if Hgb is above 11 g/dL

what drug is used to treat CKD anemia

Vadadustat (a PO HIF-PHI)

what can limit response to ESAs

Iron, folic acid, vit C or vit B12 deficiencies,

❖ infection, blood loss/hemolysis,

❖ AL overload,

❖ Cancer, malnutrition

Vadadustat ADR

HTN, diarrhea, hepatotox, seizure

Vadadustat BBW

death, MI, stroke, BTE, thrombosis

Vadadustat CI

uncontrolled HTN; avoid if Hbg is above 11 g/dL

Vadadustat DDi

Fe/phosphate binders ↓ absorption (give vadadustat ≥ before)

↑ statin levels

Vadadustat brand

Vafseo

how Vadadustat works (HIF-PHI)

inhibits the prolyl hydroxylase enzyme

• allows more HIF to trigger body to think low oxygen (hypoxic)

• make more EPO, so make more RBCs

what two vit are associated with macrocytic anemia? why?

decreased B12 or decreased b9

• DNA synth slows w/o these vitamins, so fewer cells split— bigger and “hollow” kind of

is MCV high or low in macrocytic anemia? is HgB high or low in macro?

MCV: high

Hgb: low

what is 1st line for macrocytic anemia

b12 injection

what macrocytic condition requires life-long b12 injection

pernicious anemia

what vitamin is cyanocobalamin

vit b12

what vitamin is folate

vit b9

what does vit b12 (cobalamin) do

assists folate in synth of DNA, act as coenzyme in aa/fa metabolism, promote cell and RBC grwoth

how is pernicious anemia related to b12 def? how present?

immune system attacks intrinstic factor s/t b12 cannot be absorbed

• weakness, bleeding gum, numb hands/legs, poor memory, depression, demyelination of CNS (loss of memory and dementia)

what are effects of b12 OD

no toxic effects

what are effects of b9 OD

mild GI upset

what is function of b9

rna/dna synth, coenzyme in his to glu conversion, converted to tetrahydrofolate (THF)— dr bennett calls it th4

what happens when folate def

a type of megaloblastic anemia (macrocyt) where RBCs can’t divide

what amino acid precursor can b12, b6 and esp folate decrease and whyyy

homocysteine

• the folate provides methyl to remethylate back into methionine for DNA synth

what vitamin do preg women take to prevent neural tube defects

folate