p.15
Drug Interactions Affecting Anemia Treatment
What is the effect of antifolate drugs on folic acid?
They inhibit the enzymes that convert folic acid to tetrahydrofolic acid (folinic).
p.2
Erythropoiesis-Stimulating Agents (ESAs)
What is a common example of an erythropoiesis stimulating agent?
Recombinant erythropoietin.
p.9
Adverse Effects and Toxicity of Iron
What are common gastrointestinal side effects of oral iron?
Nausea, vomiting, epigastric pain, abdominal cramps, constipation or diarrhea.
p.12
Vitamin B12 and Folic Acid Deficiencies
What are the common supplements for Vitamin B12?
Cyanocobalamin and hydroxocobalamin.
Why is it important to determine the cause of anemia?
To properly treat anemia.
p.15
Drug Interactions Affecting Anemia Treatment
Which drugs decrease the absorption of folic acid?
Anticonvulsants (e.g., phenytoin & phenobarbital), oral contraceptives, long-term use of aspirin, and caffeine.
p.2
Erythropoiesis-Stimulating Agents (ESAs)
What are erythropoiesis stimulating agents used for?
To stimulate the production of red blood cells.
What can lead to inadequate erythropoiesis?
Impaired marrow production and nutritional deficiencies (iron, vitamin B12, and folic acid).
p.14
Megaloblastic Anemia and Treatment Options
What is a therapeutic use of Folic Acid?
Treatment of megaloblastic anemia due to folate deficiency.
p.16
Adverse Effects and Toxicity of Iron
What risks are associated with elevated Hb levels above 12 g/dL?
Increased risk of hypertension, stroke, myocardial infarction, heart failure, and death.
p.14
Megaloblastic Anemia and Treatment Options
How is Folic Acid administered for treating anemia?
Oral or parenteral, depending on the severity of anemia and absorption adequacy.
p.3
Iron Deficiency Anemia Management
Which foods are recommended in the diet for treating iron deficiency anemia?
Meat, dates, nuts, and green leafy vegetables.
p.1
Definition and Overview of Anemia
What is anemia?
A reduction in the concentration of hemoglobin (Hgb) that results in reduced oxygen-carrying capacity of the blood.
p.7
Iron Deficiency Anemia Management
Why might treatment of other types of anemia require iron?
Because increased RBC synthesis will need iron.
p.9
Adverse Effects and Toxicity of Iron
What are some systemic adverse effects of parenteral iron?
Headache, back pain, arthralgia, fever, lymphadenopathy, and anaphylactoid reactions.
p.4
Iron Kinetics and Absorption Factors
What are the main uses of iron distributed to tissues?
For hemoglobin, myoglobin, and enzymes.
p.10
Adverse Effects and Toxicity of Iron
What are some manifestations of acute iron toxicity?
Necrotizing gastroenteritis, nausea and vomiting, hematemesis, and bloody diarrhea.
p.6
Iron Kinetics and Absorption Factors
Which drugs can act as chelators and affect iron absorption?
Tetracyclines, levothyroxine, and ciprofloxacin.
p.11
Megaloblastic Anemia and Treatment Options
How should megaloblastic anemia be treated?
By administering both Vitamin B12 and folic acid.
p.3
Iron Deficiency Anemia Management
What is the purpose of iron therapy in treating iron deficiency anemia?
To replace the iron necessary for red blood cells (RBCs).
What are the main causes of anemia?
Inadequate erythropoiesis, increased hemolysis, and blood loss.
What are some conditions that can impair marrow production?
Myelosuppressive drugs, irradiation, infection, cancer, chronic kidney diseases, chronic immune-related diseases, and chronic inflammation.
p.14
Megaloblastic Anemia and Treatment Options
Why should Folic Acid not be used in undiagnosed megaloblastic anemia?
It may improve symptoms if due to folate deficiency, but neurological lesions from B12 deficiency will persist.
p.8
Iron Deficiency Anemia Management
What are the indications for parenteral iron therapy?
Failure of oral iron therapy or persistent chronic causes like chronic severe anemia or chronic renal disease on hemodialysis.
p.8
Iron Deficiency Anemia Management
What is the initial test dose protocol for parenteral iron?
Administer an initial test dose and observe the patient for allergic reactions.
p.10
Adverse Effects and Toxicity of Iron
What is the purpose of intermittent phlebotomy in iron toxicity management?
To reduce excess iron in the absence of anemia.
p.13
Vitamin B12 and Folic Acid Deficiencies
How is Vitamin B12 used in pernicious anemia treatment?
Initial intramuscular intensive treatment phase, followed by lifelong maintenance therapy.
p.2
Megaloblastic Anemia and Treatment Options
What deficiencies are treated with combined Vitamin B12 and Folic acid?
B12 and/or folic deficiency.
p.12
Vitamin B12 and Folic Acid Deficiencies
What are the essential functions of Vitamin B12?
Cell replication, hematopoiesis, and myelin synthesis.
p.12
Vitamin B12 and Folic Acid Deficiencies
How can Vitamin B12 be synthesized apart from dietary sources?
Through GI microorganism synthesis.
p.9
Adverse Effects and Toxicity of Iron
What technique can reduce local adverse effects from intramuscular iron injections?
Using deep injection with a Z technique.
p.10
Adverse Effects and Toxicity of Iron
What is a common cause of acute iron toxicity in children?
Accidental ingestion of iron tablets.
p.4
Iron Kinetics and Absorption Factors
What happens to RBCs after 120 days?
They are degraded by reticuloendothelial cells.
p.10
Adverse Effects and Toxicity of Iron
What severe complications can arise from excess iron deposition?
Organ failure, including bronzed diabetes.
p.13
Vitamin B12 and Folic Acid Deficiencies
What is a prophylactic use of Vitamin B12?
Prophylaxis for folic or iron deficiency anemia and for pregnant women.
p.2
Erythropoiesis-Stimulating Agents (ESAs)
What type of drugs are used as bone marrow stimulants?
Erythropoiesis stimulating agents.
p.14
Vitamin B12 and Folic Acid Deficiencies
What is the primary role of Folic Acid?
Essential for DNA synthesis and cell proliferation.
p.8
Iron Deficiency Anemia Management
What are the common oral iron preparations?
Ferrous sulfate, ferrous gluconate, and ferrous fumarate.
p.8
Iron Deficiency Anemia Management
What is the typical dosage of elemental iron for oral administration?
100 - 200 mg given per day in divided doses.
p.14
Vitamin B12 and Folic Acid Deficiencies
Who should take Folic Acid to prevent deficiency?
Susceptible individuals such as pregnant women, premature infants, and those with severe chronic hemolytic anemia.
p.4
Iron Kinetics and Absorption Factors
How is iron excreted from the body?
Via exfoliation of intestinal cells in stool, bile, urine, and sweat.
p.10
Adverse Effects and Toxicity of Iron
What supportive treatments are recommended for iron toxicity?
Supportive treatment for gastrointestinal bleeding, acidosis, and shock.
p.13
Vitamin B12 and Folic Acid Deficiencies
What is a therapeutic use of Vitamin B12 for megaloblastic anemia?
It is used to treat megaloblastic anemia.
p.3
Iron Deficiency Anemia Management
When is a blood transfusion necessary in the treatment of iron deficiency anemia?
In cases of excessive blood loss, heart failure, or when immediate replenishment is required.
p.16
Erythropoiesis-Stimulating Agents (ESAs)
What are erythropoiesis-stimulating agents (ESAs)?
Synthetic proteins that mimic erythropoietin, including Recombinant human EPO (epoetin alfa) and epoetin β (pegylated form).
p.16
Erythropoiesis-Stimulating Agents (ESAs)
What precautions should be taken when administering ESAs?
They should be given with iron, B12, and folic supplements to support erythropoiesis.
p.6
Iron Kinetics and Absorption Factors
What role do Vitamin C and HCl play in iron absorption?
They help convert ferric iron to ferrous iron, enhancing absorption.
p.8
Iron Deficiency Anemia Management
How should iron dextran be administered?
Slow IV infusion in 500 ml saline over 1 - 2 hours.
p.13
Vitamin B12 and Folic Acid Deficiencies
What is the role of Hydroxocobalamin in cyanide poisoning?
It combines with cyanide to form harmless cyanocobalamin in the blood.
p.7
Iron Deficiency Anemia Management
What condition can lead to inadequate iron absorption?
Gastrectomy and malabsorption.
p.7
Iron Deficiency Anemia Management
How does chronic kidney disease (CKD) relate to iron deficiency?
It leads to decreased erythropoietin production.
p.9
Adverse Effects and Toxicity of Iron
How can staining of teeth and black stools from oral iron be minimized?
By taking iron after meals and using enteric-coated sustained-release iron preparations.
p.12
Vitamin B12 and Folic Acid Deficiencies
What routes can Vitamin B12 be administered?
Orally (p.o.), parenterally, or as sublingual (SL) or nasal spray.
p.10
Adverse Effects and Toxicity of Iron
What is hemosiderosis?
Increased blood transfusion leading to excess iron accumulation.
p.6
Iron Kinetics and Absorption Factors
What are some examples of malabsorption syndromes that affect iron absorption?
Celiac disease is one example.
p.13
Vitamin B12 and Folic Acid Deficiencies
How is Vitamin B12 used in treating peripheral neuropathy?
It is especially used for diabetic neuropathy.
p.7
Iron Deficiency Anemia Management
What chronic condition can lead to iron deficiency anemia due to blood loss?
Peptic ulcer (PU) and menorrhagia.
p.16
Erythropoiesis-Stimulating Agents (ESAs)
What are the indications for using ESAs?
1. Anemia of chronic renal failure. 2. Bone marrow suppression (e.g., cancer chemotherapy or zidovudine for AIDS).
p.4
Iron Kinetics and Absorption Factors
Where is Fe2+ absorbed in the body?
From the upper small intestine (SI).
p.12
Vitamin B12 and Folic Acid Deficiencies
Where is Vitamin B12 absorbed in the body?
From the distal ileum after binding to intrinsic factor (IF).
p.12
Vitamin B12 and Folic Acid Deficiencies
What is intrinsic factor (IF) and its role in Vitamin B12 absorption?
IF is secreted from parietal cells with HCl and is necessary for B12 absorption.
p.6
Iron Kinetics and Absorption Factors
What happens to iron absorption if Vitamin C or HCl levels are low?
Ferric iron increases, leading to decreased absorption.
p.10
Adverse Effects and Toxicity of Iron
What is deferoxamine used for?
It is an iron chelating compound used to treat iron toxicity.
p.7
Iron Deficiency Anemia Management
What is an example of increased iron requirement?
Pregnancy and premature babies.
p.12
Vitamin B12 and Folic Acid Deficiencies
What are the dietary sources of Vitamin B12?
Dietary meats, dairy products, and eggs.
p.9
Adverse Effects and Toxicity of Iron
What local adverse effects can occur with parenteral iron injections?
Pain, inflammation, and brown staining with intramuscular injection.
p.8
Iron Deficiency Anemia Management
Why should oral iron be taken with food?
To reduce gastric distress caused by iron.
p.12
Vitamin B12 and Folic Acid Deficiencies
What condition can result from a deficiency of intrinsic factor?
Vitamin B12 deficiency leading to pernicious anemia.
p.4
Iron Kinetics and Absorption Factors
What happens to iron after RBC degradation?
It returns to plasma or is stored, with small amounts excreted.
p.10
Adverse Effects and Toxicity of Iron
What is one treatment method for acute iron toxicity?
Gastric lavage using phosphate or carbonate solutions.
p.11
Megaloblastic Anemia and Treatment Options
What type of anemia is caused by a deficiency in Vitamin B12 and/or folic acid?
Megaloblastic anemia (macrocytic).
p.15
Drug Interactions Affecting Anemia Treatment
Name some antifolate drugs that affect folic acid production.
Methotrexate, trimethoprim, and pyrimethamine.
What causes red cell deficiency anemia (Anemia of CRF)?
Deficiency of Erythropoietin, which is essential for RBC formation in the bone marrow.
p.16
Erythropoiesis-Stimulating Agents (ESAs)
How is epoetin alpha administered?
It is given intravenously or subcutaneously 1-3 times per week to target Hb levels between 10-12 gm/dL.
p.9
Adverse Effects and Toxicity of Iron
Is anaphylaxis common with parenteral iron administration?
No, it is very rare but can occur.
p.6
Iron Kinetics and Absorption Factors
How do iron requirements and stores affect iron absorption?
Iron absorption increases with higher requirements and decreases with higher iron stores.
p.14
Adverse Effects and Toxicity of Iron
What is the role of Leucovorin calcium?
To prevent toxicity of antifolate drugs.
p.6
Iron Kinetics and Absorption Factors
What are some precipitating factors that can decrease iron absorption?
Tannic acid from tea, phytates from plant origin, and carbonates.
What are some causes of Vitamin B12 deficiency?
Decrease intake (vegetarians), malabsorption, gastrectomy (IF), tapeworm infection, pernicious anemia.
p.8
Iron Deficiency Anemia Management
What is the administration method for Ferric gluconate and Iron sucrose?
Only IV with less hypersensitivity.
p.8
Iron Deficiency Anemia Management
How is the total iron requirement calculated for a patient?
Based on hemoglobin deficit, usually 1 - 2g (20 - 40 ml) of iron dextran.
p.11
Megaloblastic Anemia and Treatment Options
What happens in megaloblastic anemia due to Vitamin B12 and folic acid deficiency?
Continued cell growth occurs without DNA synthesis.
p.13
Drug Interactions Affecting Anemia Treatment
Why can decreased HCl affect Vitamin B12 absorption?
Because B12 cannot combine with intrinsic factor.
p.14
Vitamin B12 and Folic Acid Deficiencies
What fetal defect can result from Folic Acid deficiency during pregnancy?
Neural tube defects, such as cleft lip, cleft palate, and spina bifida.
p.6
Iron Kinetics and Absorption Factors
How do chelators affect iron absorption?
They form non-absorbable complexes with iron, decreasing absorption.
p.11
Vitamin B12 and Folic Acid Deficiencies
What role does Vitamin B12 play in DNA synthesis?
It acts as a co-factor to convert dihydrofolic acid to active folinic acid.
p.13
Drug Interactions Affecting Anemia Treatment
Which drugs can decrease the absorption of Vitamin B12?
Colchicine, neomycin, chronic heavy alcohol intake, and drugs that decrease HCl.
