Anemia - Pathophysiology I - Lecture 1 (1)

Deficiency inadequate intake sources meat liver

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DEFICIENCY Inadequate intake Sources: meat, liver, legumes, cereal, leafy veggies RDA: 400 mcg/day Women of childbearing age: 400 mcg/day Pregnant women: 600 mcg/day FDA mandated cereals to be fortified with “adequate” folate (1998) At-risk populations Alcoholism Elderly and teenagers Poverty stricken Pregnancy
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Iron deficiency anemia ETIOLOGY – FOLIC ACID DEFICIENCY Malabsorption Intestinal disorders Hyperutilization Pregnancy Adolescents and infants during growth spurts Drug-Induced Methotrexate (chemotherapy agent) Trimethoprim (antibiotic)
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FOLATE DEFICIENCY COMPLICATIONS Pregnancy Neural tube defects RDA Women of childbearing age: 400 mcg/day Pregnant women: 600 mcg/day
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LABORATORY FINDINGS Peripheral Smear: RBCs are placed on a microscope slide, stained and viewed Macrocytic RBCs Normochromic RBCs Laboratory findings: Large MCV Normal MCHC
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FOLATE DEFICIENCY LABORATORY FINDINGS Decreased RBC Hgb and Hct Reticulocyte count Folic acid level (<3 ng/ml) Normal Normal MCHC Normal B 12 level Increased MCV
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FOLATE DEFICIENCY TREATMENT GOALS Goals of therapy Replenish folate stores Dietary supplements through exogenous folate preparations Treat the underlying cause/disease to aid in the correction of folic acid stores Reversal of hematologic laboratory findings
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CLINICAL SCENARIO #2 CLINICAL SCENARIO #2 AO is a 55 yo WM who presents to his primary care physician (PCP) complaining of general fatigue, headaches and difficulty breathing while playing sports with his son. PMH : HTN, alcoholism and asthma Current meds: HCTZ 25mg po daily, Albuterol inhaler 2 puffs four times daily Vitals : BP 185/92 mmHg, HR 90 bpm, RR 22 bpm
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CLINICAL SCENARIO #2 CLINICAL SCENARIO #2 ROS : Denies BRBPR and hematuria CBC : WBC - 12.3X 10 6 /mm 3 Hemoglobin (Hgb) - 9.9 g/dL Hematocrit (Hct) – 30.1% Platelets – 305,000 Laboratory blood work : RBC 4.5 X 10 6 /mm 3 Reticulocyte count 0.4% MCV 115 fL MCH 32 pg MCHC 37 g/dL
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CLINICAL SCENARIO #2 CLINICAL SCENARIO #2 Further blood work is done to determine the cause of anemia. Findings are significant for: Iron saturation 50% Folate 2 ng/ml Serum B 12 level 440 ng/L
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CLINICAL SCENARIO #2 CLINICAL SCENARIO #2 Based on the additional blood work what is the etiology of AO’s anemia? What are AO’s risk factor(s) for anemia? If a peripheral smear was performed, what would be the likely morphology?
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Anemia - Pathophysiology I Ginah Nightingale, Pharm.D., BCOP Assistant Professor Jefferson School of Pharmacy October 10, 2012
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