Signs and symptoms

• Fatigue, weakness, SOB, palpitation, lightheadedness, pallor (pale skin), glossitis
• Koilonychias, thin/concave/spoon-shaped nail, brittle nails, pica (craving and eating junk food)

 

Lab values

• HGB: 13-18 male, 12- 16 female
• Hct: 37 - 49 male, 36 - 46 female
• MCV (avg. volume of RBC): 80 - 100

 

Microcytic/iron-deficiency anemia

• Named from smaller than normal size erythrocytes (MCV < 80)
• Low Hgb/Hct level
• Treated w/ iron

 

Macrocytic anemia

• Named from larger than normal size erythrocytes (MCV > 100), blood with an insufficient concentration of hemoglobin (Low Hgb/Hct level).
• Due to V-B₁₂ or folate deficiency, common causes are: alcoholism, GI diseases (Crohn's, Celiac); this type of anemia can cause neurological complication.
• Treat with V-B₁₂, folic acid.
• Pernicious anemia is a common type due to lack of intrinsic factor (Schilling test can diagnose deficiency of intrinsic factors), this type requires lifelong B12 injection.
• Drugs decrease folic acid: phenytoin, primidone, oral contraceptive, cholestyramine, AZA, 6-mercaptopurine, MTX, 6-thioguanine and pentamide.

 

Normocytic anemia

• Renal disease causes anemia due to lack of erythropoietin – EPO, a hormone produced by healthy kidney, which can stimulate bone marrow to produce RBC
• MCV value may be normal due to lack of erythropoietin
• Treat with ESA - erythropoiesis stimulating agent SQ injection

 

Iron

• Must be absorbed in acidic environment, recommend taking with vitamin C, avoid agents raise pH
• Antibiotics (TCN, quinolone) can decrease iron absorption through chelation
• Caution iron overdose: N/V, GI bleeding, diarrhea. Antidote - deferoxamine (Desferal)
• Carbonyl iron: highest amount of iron
• Ferrous bisglycinate: good absorption, possibly less nausea
• IV
  • Iron dextran: slow infusion, NTE 100mg/day, test dose for anaphylaxis risk
  • Sodium ferric gluconate complex (Ferrlecit): hypoTN
  • Iron sucrose (Venofer): hypoTN

 

ESA - erythropoiesis stimulating agent

• Drugs: Neupogen (filgrastim), Neulesta (pegfilgrastim), Aranesp (darbepoetin)
• Restricted prescribing, prescribers must enroll ESA APPRISE oncology program.
• Do not shake the vial, store with refrigeration.
• SE: Bone pain, HTN, clotting risk, stroke, heart or circulatory problems.
• BBW: renal failure, cancer (use ESA only in Hgb<10)
• Filgrastim, pegfilgrastim: refrigerate, protect from light.
• Darbepoetin: last longer than other ESA, the advantage is less frequent dosing, mg/kg SC q 2-3 weeks

 

 

Was this page helpful?

Back to top »