Summary of Chapter 122: Anemias (from DiPiro’s Pharmacotherapy, 12th Ed.) Dr. Nehad Jaser (summarized by AI)

 

Overview

  • Anemia is a condition defined by reduced hemoglobin (Hb) or red blood cell (RBC) count, leading to decreased oxygen-carrying capacity.

  • WHO criteria: Hb <13 g/dL in men, <12 g/dL in women.

  • Causes: decreased RBC production, increased destruction, or blood loss.

Clinical Presentation

  • Acute anemia: tachycardia, lightheadedness, dyspnea.

  • Chronic anemia: fatigue, weakness, headache, pallor, vertigo.

  • Symptoms vary with age, comorbidities, and speed of onset.

  • B12 deficiency may cause neurologic complications (paresthesia, memory impairment, ataxia).

Major Types of Anemia

  1. Iron-Deficiency Anemia (IDA)

    • Most common worldwide.

    • Markers: ↓ ferritin (earliest), ↓ serum iron, ↓ transferrin saturation, ↑ TIBC.

    • RBCs: microcytic, hypochromic.

    • Causes: poor diet, chronic blood loss, pregnancy, increased demand.

    • Treatment: oral iron (150–200 mg elemental/day); parenteral if intolerant or malabsorption.

  2. Vitamin B12 Deficiency

    • Macrocytic anemia.

    • Causes: low intake, malabsorption, pernicious anemia (lack of intrinsic factor).

    • Symptoms: anemia + neurologic dysfunction (can become irreversible).

    • Treatment: oral or parenteral B12 replacement.

  3. Folic Acid Deficiency

    • Macrocytic anemia.

    • Causes: poor intake, alcoholism, increased demand (e.g., pregnancy).

    • Treatment: oral folic acid.

    • Prevention: essential in pregnancy to prevent neural tube defects.

  4. Anemia of Inflammation (AI)

    • Includes anemia of chronic disease & critical illness.

    • Cause: chronic inflammation, infection, or malignancy.

    • Labs: ↓ serum iron, but ferritin normal or high (distinguishes from IDA).

    • Treatment: address underlying disease; limited benefit from iron therapy.

Special Populations

  • Older adults: anemia linked to higher risk of hospitalization, mortality, cognitive decline.

  • Children: IDA causes irreversible developmental delays; prevention is key.

  • Pregnancy: anemia increases risk of preterm birth, low birth weight, maternal complications.

Diagnostic Workup

  • Initial labs: CBC, RBC indices, reticulocyte count, iron studies, B12, folate.

  • Classifications:

    • Microcytic (e.g., IDA)

    • Macrocytic (e.g., B12/folate deficiency)

    • Normocytic (e.g., acute blood loss, chronic disease)

Patient Care Process

  1. Collect: history, diet, meds, labs.

  2. Assess: cause of anemia, comorbidities, severity.

  3. Plan: dietary & drug therapy (iron, B12, folate, etc.), patient education.

  4. Implement: reinforce adherence, adjust therapy.

  5. Follow-up: monitor labs within 4 weeks, assess symptoms and tolerability.

Key Takeaways

  • Anemia is common but often underdiagnosed.

  • IDA is the leading global cause.

  • Early recognition and treatment are critical to prevent irreversible complications (neurologic damage in B12 deficiency, developmental delay in children).

  • Management requires identifying and correcting the underlying cause, not just treating lab values.

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