Mod 10 Anemia Notes PDF

Anemia ● What are the 3 foundational nutrients for hematopoiesis? ○ Iron, vitamin B12; folic acid ● Anemia is a deficiency of ○ Erythrocytes ● Name the 6 sub-types of anemia and their treatments ○ Iron deficiency→ microcytic/hypochromic→ oral ferrous sulfate ○ Thalassemia→ microcytic/hypochromic→ RB...

Anemia ● What are the 3 foundational nutrients for hematopoiesis? ○ Iron, vitamin B12; folic acid ● Anemia is a deficiency of ○ Erythrocytes ● Name the 6 sub-types of anemia and their treatments ○ Iron deficiency→ microcytic/hypochromic→ oral ferrous sulfate ○ Thalassemia→ microcytic/hypochromic→ RBC transfusion ○ Folic acid→ macrocytic/normochromic→ folate ○ Pernicious→ macrocytic/normochromic→ vitamin B12 ○ Anemia of chronic disease→normocytic/normochromic→treat underlying cause +/-ESA ○ Sickle cell→ supportive care You will not be required to know if the anemias in the chromic/cytic descriptions (but this would be very helpful to learn for future practice) Oral Iron—ferrous salts ● MOA ○ Exogenous Fe absorbed by the small bowel then transported via transferrin to erythroid precursor cells to bind to Hgb as it matures into RBCs ● SE ○ GI→ constipation, pain, cramps, diarrhea, black tarry stool ● Indications ○ Iron deficiency anemia ● Contraindications ○ Thalassemia ○ Bowel obstruction ● Monitoring ○ CBC; transferrin saturation; ferritin, TIBC ○ Iron toxicity→ multi organ failure ○ Drug interactions with acid reducing meds like TUMS ● Facts IV Iron ● MOA ○ Same as above ● SE ○ Hypotension ○ Iron toxicity ● Indications ○ Same as above ● Contraindications ○ Same as above ● Monitoring ○ Same as above ● Facts ○ BBW for anaphylaxis→ must give first dose test (iron dextran) Folate/Folic Acid/B9 ● MOA ○ Exogenous replacement when PO isn’t enough ● SE ○ None ● Indications ○ Same as MOA ● Contraindications ○ Untreated B12 deficiency ● Monitoring ○ Reticulocyte count ○ Megaloblast no longer present in peripheral smear ● Facts ○ Good for pregnancy ○ Folic acid can mask B12 deficiency s/s until dangerous neuro s/s appear B12/Cyanocobalamin ● MOA ○ Replace loss from disease ● SE ○ hypoK ● Indications ○ Same as MOA ● Contraindications ○ None ● Monitoring ○ B12 Q 3-6 mon ● Facts ○ Therapy is forever if you have gastric mucosal atrophy ESA—erythropoietin ● MOA ○ Exogenous glycoprotein hormone that is a hematopoietic growth factor→ stimulates erythroid proliferation and differentiations→ makes more RBCs ● SE ○ Injection site reactions; thrombotic events ● Indications ○ Anemia r/t CKD ○ Anemia r/t HIV ○ Anemia r/t chemo/radiation ● Contraindications ○ Poorly controlled HTN ○ Tumor ○ Surgical pts ○ Professional athletes ● Monitoring ○ Reticulocyte count should improve in about 10 days ○ H/H increases within 2-6 wks pRBC ● When/what lab values make this transfusion a consideration in clinical practice? ○ Typically, a pRBC transfusion is considered when the Hgb level falls below 7-8 g/dL or when there are signs and symptoms of inadequate oxygen delivery to tissues. Clinical judgment also plays a significant role. ● Does it need to be crossed and matched? ○ pRBC transfusions generally require ABO and Rh(D) compatibility. Crossmatching is done to minimize the risk of hemolytic transfusion reactions. ● What does the APP need to monitor pre and post transfusion? ○ The APN should monitor the patient for signs and symptoms of transfusion reactions (such as fever, chills, rash, or hypotension). Additionally, vital signs, oxygen saturation, and hemoglobin levels should be closely monitored posttransfusion. Platelets ● When/what lab values make this transfusion a consideration in clinical practice? ○ Platelet transfusion is considered when the platelet count is less than 10,000/uL or in cases of significant bleeding with a platelet count of less than 50,000/uL ● Does it need to be crossed and matched? ○ Platelet transfusions do not typically require crossmatching because they lack significant red cell antigens. However, ABO compatibility is still preferred. ● What does the APP need to monitor pre and post transfusion? ○ Before the transfusion, the APN should ensure that there is no active bleeding and assess the patient’s platelet count. Post-transfusion monitoring should include vital signs and assessment for signs of transfusion reactions. Additionally, platelet count monitoring may be necessary to evaluate the effectiveness of the transfusion. FFP ● When/what lab values make this transfusion a consideration in clinical practice? ○ FFP transfusion is considered in cases of significant bleeding or when there is a need for urgent reversal of anticoagulation. Coagulation studies such as an elevated INR in the absence of bleeding may also prompt FFP transfusion. ● Does it need to be crossed and matched? ○ FFP transfusions typically do not need to be crossmatched, as they contain no red blood cells. However, ABO compatibility is still recommended. ● What does the APP need to monitor pre and post transfusion? ○ Prior to transfusion, the APN should assess coagulation studies and the patient’s bleeding status. Post-transfusion monitoring includes vital signs, signs of transfusion reactions, and coagulation parameters (such as INR and PT). Cryoprecipitate ● When/what lab values make this transfusion a consideration in clinical practice? ○ Cryoprecipitate is considered in cases of hypofibrinogenemia or dysfibrinogenemia. This might be indicated when the fibrinogen level is less than 100mg/dL. ● Does it need to be crossed and matched? ○ Cryoprecipitate is usually administered without crossmatching because it contains only small amounts of plasma. ● What does the APP need to monitor pre and post transfusion? ○ Prior to transfusion, the APN should assess the patient’s coagulation profile, particularly fibrinogen levels. Posttransfusion monitoring includes vital signs, signs of transfusion reactions, and fibrinogen levels to assess the effectiveness of the transfusion.