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Anemia, (daily dosage of 150-200 mg elemental iron in 2-3 divided doses,…
Anemia
Diagnosis
Get hx of
: diet, medications, chronic diseases, blood transfusions, exposure to toxic materials, etc.
Sx
: dec. exercise tolerance, fatigue, dizziness, irritability, weakness, palpitations, vertigo, SOB, chest pain, neurologic sx in vit. B12 deficiency anemia
Severity of symptoms doesn't correlate with severity of disease
Signs
: tachycardia, pale appearance, dec. mental acuity, inc. intensity of some cardiac murmurs, diminished vibratory sense and changed gait in vit. B12 deficiency anemia
Lab tests:
Hb, hematocrit, RBC count, serum iron, ferritin levels (low in IDA), cell volume, homocysteine and methylmalonic acid levels, blood smear
Treatment (IDA)
Oral (preferred)
Ferrous Sulfate
20% elemental iron
Ferrous gluconate
12% elemental iron
Ferrous fumarate
33% elemental iron
Parenteral
Iron dextran, sodium ferric gluconate, iron sucrose, ferric carboxymaltose
for patients with iron malabsorption, intolerance of oral iron therapy, or nonadherence
use in CKD patients who are on hemodialysis, or patients who don't/won't tolerate oral therapy
Nonpharm - Address dietary habits and potential social factors like alcohol
Recommended screening for IDA in all pregnant women. Guidelines recommend initiation of low-dose iron supplement or prenatal vitamin with 30 mg/day of iron at each woman's first prenatal visit
Types of Anemia
Iron deficient (Microcytic)
Men: Serum Hb < 13g/ml
Women: Serum Hb <12g/ml
Labs: decreased serum ferritin (storage iron), decreased transferrin saturation, and increased total iron-binding capacity (TIBC)
Causes
:
Decreased intake and absorption of Fe
Increassed utilization of Fe
Innefficent metabolisim of FE
Blood Loss
Macrocytic
B12 and folic acid deficiency
B12 less than 200pg/mL
folate less than 3ng/mL
Pernicious anemia - lack of instrinic factor
Thalassemia and Hemophilia
Others - liver disease, hypothyroidism, or hyperlipidemia; aplastic anemia, myelodysplastic syndromes and lympocyte leukemia
Normocytic
Chronic Inflammation via:
malignancy, illness, etc.
Blood loss
Goals of Care:
alleviate signs or sx
correct underlying etiology
prevent recurrence
Causes
RBC production failure (hypoproliferative
cell maturation ineffectiveness
Increased RBC destruction or loss
Pathophysiology
: characterized by either a decrease in hemoglobin or volume of red blood cells. This results in decreased oxygen-carrying capacity of blood and can have numerous causes. Negative balance of iron over a long period.
(daily dosage of 150-200 mg elemental iron in 2-3 divided doses, preferably without food)
• Iron is best absorbed in its ferrous form of (FE3+) in stomach it is reduced to its Fe2+ state