Pharmacotherapy III: Anaemias

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Questions and Answers

What is the recommended treatment for vitamin B12 deficiency anemia in patients with neurologic symptoms?

Oral cobalamin 1 mg daily for 1 month

IM cyanocobalamin 1000 mcg daily for 1 week

Parenteral therapy with 1000 mcg daily for 1 week, then weekly for 1 month, and then monthly (correct)

Oral vitamin B12 supplementation at 1 to 2 mg daily for 1 to 2 weeks

What is the recommended daily dose of oral folate for the treatment of folic acid–deficiency anemia?

2 mg

5 mg

0.5 mg

1 mg (correct)

What is the primary focus of treating anemia of inflammation?

Oral vitamin B12 supplementation

Folic acid supplementation

Parenteral iron therapy

Correcting reversible causes (correct)

What is the formula used to estimate the total dose of parenteral iron needed to correct anemia?

Not specified in the text Signup and view all the answers

Which of the following is an indication for parenteral iron therapy?

Iron malabsorption Signup and view all the answers

What is the recommended duration of oral folate supplementation for the treatment of folic acid–deficiency anemia?

4 months Signup and view all the answers

Which of the following is NOT a parenteral iron preparation?

Ferrous sulfate Signup and view all the answers

In patients with pernicious anemia, which of the following is an effective treatment option?

Either oral or parenteral vitamin B12 supplementation Signup and view all the answers

What is the primary function of Erythropoietin (EPO) in the body?

To stimulate the production of RBCs Signup and view all the answers

A patient is diagnosed with microcytic anemia. What is the most likely cause of this condition?

Iron deficiency Signup and view all the answers

What is the definition of anemia according to the World Health Organization?

Hb less than 13 g/dL in men and less than 12 g/dL in women Signup and view all the answers

What is the role of the kidney in erythropoiesis?

To secrete EPO in response to cellular hypoxia Signup and view all the answers

What is the term for the process by which RBCs are produced in the bone marrow?

Erythropoiesis Signup and view all the answers

What is the term for anemia characterized by RBCs that are larger than normal?

Macrocytic anemia Signup and view all the answers

What can cause vitamin B12 deficiency anemia?

Inadequate dietary intake or decreased absorption Signup and view all the answers

What is the primary cause of iron-deficiency anemia?

All of the above Signup and view all the answers

What is a cause of folic acid deficiency anemia?

Hyperutilization due to pregnancy Signup and view all the answers

What is the process by which reticulocytes mature into erythrocytes?

After 1 to 2 days in the bloodstream Signup and view all the answers

What is the term used to describe anemia of chronic disease and anemia of critical illness?

Anemia of inflammation Signup and view all the answers

What is a symptom of chronic anemia?

Weakness, fatigue, and headache Signup and view all the answers

What can cause anemia by reducing absorption of folate?

Phenytoin Signup and view all the answers

What is a characteristic of iron deficiency anemia?

Glossal pain, smooth tongue, reduced salivary flow, and pica Signup and view all the answers

What is an effect of vitamin B12 deficiency?

Neurologic effects such as numbness and ataxia Signup and view all the answers

What is a characteristic of acute-onset anemia?

Cardiorespiratory symptoms such as palpitations, angina, and breathlessness Signup and view all the answers

Study Notes

Overview of Anemia

Anemia is a group of diseases characterized by a decrease in either hemoglobin (Hb) or the volume of red blood cells (RBCs), resulting in decreased oxygen-carrying capacity of blood.
The World Health Organization defines anemia as Hb: less than 13 g/dL in men or less than 12 g/dL in women.

Erythropoiesis

Erythropoiesis begins with a pluripotent stem cell in the bone marrow undergoing differentiation and ends with the appearance of RBCs in peripheral blood.
The production of RBCs is stimulated by EPO, a hormone secreted by the kidney in response to cellular hypoxia.
EPO stimulates RBC production by inducing differentiation of RBC precursors in the bone marrow to become reticulocytes.
Reticulocytes become erythrocytes after 1 to 2 days in the bloodstream.
This process is also dependent upon a steady supply of important ingredients, iron, folic acid, and vitamin B12.

Morphologic Classifications

Morphologic classifications are based on cell size:
- Macrocytic cells are larger than normal and are associated with deficiencies of vitamin B12 or folic acid.
- Microcytic cells are smaller than normal and are associated with iron deficiency.
- Normocytic anemia may be associated with recent blood loss or chronic disease.

Iron-Deficiency Anemia (IDA)

IDA can be caused by: inadequate dietary intake, inadequate gastrointestinal (GI) absorption, increased iron demand, blood loss, and chronic diseases.
Consider parenteral iron for patients with iron malabsorption, intolerance of oral iron therapy, or nonadherence.
The available parenteral iron preparations with similar efficacy are: Iron dextran, sodium ferric gluconate, iron sucrose, ferumoxytol, and ferric carboxymaltose.

Vitamin B12-Deficiency Anemia

Oral vitamin B12 supplementation is as effective as parenteral, even in patients with pernicious anemia.
Initiate oral cobalamin at 1 to 2 mg daily for 1 to 2 weeks, followed by 1 mg daily.
Parenteral therapy acts more rapidly than oral therapy and is recommended if neurologic symptoms are present.

Folate-Deficiency Anemia

Oral folate, 1 mg daily for 4 months, is usually sufficient for treatment of folic acid– deficiency anemia, unless the etiology cannot be corrected.
If malabsorption is present, a dose of 1 to 5 mg daily may be necessary.

Anemia of Inflammation (AI)

AI should focus on correcting reversible causes.
Vitamin B12 deficiency anemias can be caused by: inadequate dietary intake, decreased absorption, and deficiency of intrinsic factor.
Folic acid– deficiency anemia can be caused by: hyperutilization, hemolytic anemia, malignancy, chronic inflammatory disorders, and long-term dialysis.
Drugs can cause anemia by reducing absorption of folate or through folate antagonism.

Clinical Presentation and Diagnosis of Anemia

Acute-onset anemia is characterized by cardiorespiratory symptoms such as palpitations, angina, and breathlessness.
Chronic anemia is characterized by weakness, fatigue, headache, dyspnea on exertion, vertigo, cold sensitivity, pallor, and loss of skin tone.
IDA is characterized by glossal pain, smooth tongue, reduced salivary flow, pica, and pagophagia.
Neurologic effects of vitamin B12 deficiency may occur, such as numbness and ataxia.

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Description

This quiz covers the definition, pathophysiology, and pharmacotherapy of anaemias, including the World Health Organization's definition of anemia. It is part of the Pharmacotherapy III course.