MindMap Gallery Anemia
This mind map classifies anemia by RBC morphology: Macrocytic (DNA synthesis defects), Microcytic (iron deficiency/thalassemia), Normocytic (acute blood loss). It establishes diagnostic pathways through etiological, lab-feature and treatment comparisons.
Edited at 2025-02-22 02:18:40This mind map compares renal replacement therapies: Peritoneal Dialysis (uses peritoneal membrane), CRRT (for critical cases), and Hemodialysis (extracorporeal blood purification). It systematically contrasts principles, indications and procedures to support clinical decision-making.
This mind map classifies anemia by RBC morphology: Macrocytic (DNA synthesis defects), Microcytic (iron deficiency/thalassemia), Normocytic (acute blood loss). It establishes diagnostic pathways through etiological, lab-feature and treatment comparisons.
Drugs for the treatment of osteoporosis mainly include sclerostin inhibitors, RANKL inhibitors, and bisphosphonates, which enhance bone density and improve osteoporotic symptoms by promoting bone formation and reducing bone resorption through different mechanisms.
This mind map compares renal replacement therapies: Peritoneal Dialysis (uses peritoneal membrane), CRRT (for critical cases), and Hemodialysis (extracorporeal blood purification). It systematically contrasts principles, indications and procedures to support clinical decision-making.
This mind map classifies anemia by RBC morphology: Macrocytic (DNA synthesis defects), Microcytic (iron deficiency/thalassemia), Normocytic (acute blood loss). It establishes diagnostic pathways through etiological, lab-feature and treatment comparisons.
Drugs for the treatment of osteoporosis mainly include sclerostin inhibitors, RANKL inhibitors, and bisphosphonates, which enhance bone density and improve osteoporotic symptoms by promoting bone formation and reducing bone resorption through different mechanisms.
Anemia
Microcytic Anemia
Classification
LOW MCV → < 80 fl
Check
iron studies:
markers
↓ serum iron
amount of iron circulating in blood bound to transferrin which is protein that transports iron
↓ ferritin
protein that stores iron in body
↓ transferrin saturation / TSAT
indicates how much of transferring protein is bound to iron
↑ total iron binding capacity / TIBC
indicates how much iron the transferrin protein can carry, or measure of binding sites available on transferrin
Indication
iron deficiency
Causes
poor dietary intake
malnutrition
vegan / vegetarian diets
disease related
▨ dementia ▨ psychosis
blood loss
acute
▨ hemorrhage
chronic
▨ heavy menses ▨ PUD ▨ IBD
drug induced
▨ NSAIDs ▨ steroids ▨ anticoagulants
decreased iron absorption
high gastric pH
▨ PPI ▨ H2Ra use
GI disease
▨ celiac disease ▨ IBD ▨ gastric bypass
increased iron requirements
mothers
▨ pregnancy ▨ lactation
ages
▨ infants ▨ adolescents
Symptoms
asymptomatic
early / mild stages
common
▨ fatigue ▨ weakness ▨ SOB ▨ HA ▨ dizziness ▨ pallor
severe
▨ acute blood loss ▨ chest pain ▨ tachycardia ▨ fainting
rare
▨ glossitis ▨ koilonychia ▨ pica
b12 def
▨ peripheral neuropathy ▨ cognitive defects
TREATMENT
GOAL
▨ 1 g/dL increase in Hgb q 2-3 weeks ▨ first line = 100-200mg elemental Fe daily
ABSORPTION
▨ food decreases absorption ▨ acidic environment increases absorption ▨ SR / EC are Ø not recommended
ORAL IRON
Agents
Ferrous Sulfate
Info
▨ 20% of elemental iron ▨ most taken oral iron ▨ taken 325mg TID
Boxed Warning
▨ accidental overdose & poisoning in children <6yrs old ▨ antidote: deferoxamine (desferal)
ADRs
▨ upset stomach ▨ nausea ▨ constipation ▨ dark tarry stools
Ferrous Gluconate
12% of elemental iron
Ferrous Fumarate
33% of elemental iron
Carbonyl Iron
100% of elemental iron
Polysaccharide Iron Complex
100% of elemental iron
DI
↑ Absorption of Iron
Vitamin C
↓ Absorption of Iron
▨ Antacids ▨ H2RA ▨ PPIs
take iron before: 2hrs after: 4hrs
Absorption ↓ because of Iron
Fluroquinolones & Tetracyclines
take iron before: 2-4hrs after: 4-8hrs
Oral Bisphosphonates
take iron after: 30mins from alendronate & risedronate after: 60mins from ibandronate
Normocytic Anemia
Classification
MCV → 80-100 fl
Check
underlying cause
Indication
1. CKD 2. Malignancy due to decreased erythropoietin production
TREATMENT
IRON
Parenteral
Info
Reserved For
▨ first line for hemodialysis pts ▨ CKD pts receiving erythropoietin stimulating agents ▨ unable to tolerate iron (stomach)
Stability
▨ all agents are stable in NS ▨ particularly faraheme stable in NS & D5W
Risks
▨ of anaphylactic reactions ▨ of hypersensitivity rreactions ▨ boxed warning: iron dextran & faraheme >> test dose req'd
ADRs
▨ hypotension ▨ chest tightness ▨ peripheral edema
Agents
Iron Dextran / INFeD
▨ 25mg test dose req'd 1hr prior to full dose ▨ no more than 100mg (2mL) per dose / per day ▨ boxed warning
Iron Sucrose / Venofer
Feraheme / Ferumoxytol
▨ boxed warning
Others: Injectafer Triferic Ferrlecit
Monitoring
▨ Hgb ▨ Hcr ▨ iron studies ▨ reticulocyte counts ▨ vital counts ▨ s/s of anaohylaxsis
ESAs
Purpose
ESAs will maintain Hgb level and decrease need for blood transfusion - but must have sufficient iron stores.
Criteria
Start: when Hgb < 10 g/dL Stop: when Hbg is or > 11 g/dL
Formulations
Epoetin Alfa / Epogen Procrit
Dosing
50-100 units/kg IV/SC 3x/weekly
Half-Life
IV: 8.5hrs SC: 24hrs
Darbepoetin Alfa / Aranesp
Dosing
0.45 mcg/kg IV/SC 1x/weekly OR
0.75 mcg/kg SC only 2x/weekly
Half-Life
IV: 25hrs SC: 48hrs
Risks
▨ risk of death increases when Hgb > 11 g/dL ▨ IV preferred in HD pts ▨ do not shake- destabilization occurs ▨ discard after 21days
boxed warnings
▨ thrombosis ▨ MI ▨ stroke ▨ death ▨ tumor progression in cancer pts
ADRs
▨ hypertension ▨ fever ▨ headache ▨ rash ▨ arthralgias
Monitoring
▨ Hgb ▨ Hct ▨ TSAT ▨ serum ferritin ▨ BP
Storage
refrigeration
Macrocytic Anemia
Classification
HIGH MCV → > 100 fl
Check
b12 & folate
Indication
▨ b12 & folate deficiency ▨ decreased Hgb & Hct ▨ decreased reticulocytes ▨ MCV > 100
Signs/Symptoms
Vitamin B12 Deficiency
▨ peripheral neuropathies ▨ other neurological dysfunction
Folic Acid Deficiency
▨ ulceration of the tongue or oral mucosa ▨ changes to skin / hair / fingernails / pigmentation
Causes
Vitamin B12 Deficiency
▨ nutritional ▨ pernicious anemia ▨ lack of intrinsic factors >> diagnosed with schilling test ▨ lifelong parenteral vitamin B12 therapy
Folic Acid Deficiency
▨ alcoholism ▨ malabsorption syndromes
Drugs: metformin / PPIs (2yrs more of use)
Treatment
Cyanocobalamin
parenteral (IM / SC)
nasal solution: nascobal 1x/weekly
Folic Acid
0.4 - 1mg / day