ABSTRACT
OBJECTIVE: We assessed the impact of acid suppression therapy (i.e., ranitidine or proton pump inhibitors) on iron supplementation and its ability to maintain or alter laboratory values that are commonly associated with anemia. METHODS: This was a prospective, observational trial. The primary outcome was changes in serum iron levels from baseline. Secondary outcomes were changes in hemoglobin (Hgb) and hematocrit (Hct), transfusions, and maintenance of an alkalotic gastric pH. RESULTS: Thirty-four patients (mean 24 ± 43 months) met inclusion criteria. The serum iron levels increased to 50.9 ± 24.6 mcg/dL by day 3. The mean difference from baseline was 1.5 mcg/dL (95% CI, 1.14-1.98, p = 0.0056). Gastric pH increased to 4.68 ± 1.49 on day 5. The mean Hgb and Hct increased on day 5 to 10 ± 1.06 g/dL and 29.6% ± 3.27%, respectively. The mean difference of Hgb was 1.15 g/dL (95% CI, 0.51-1.78, p = 0.0009). The mean difference of Hct was 3.04% (95% CI, 1.11-4.97, p = 0.0032). CONCLUSIONS: The use of antacids along with oral ferrous sulfate supplementation did not affect the absorption of iron. Serum iron, Hgb, and Hct all showed statistically significant increases despite combined antacid and iron therapy. Thus, despite use of antacids, combination use showed increases in iron absorption.
ABSTRACT
OBJECTIVES: This prospective study evaluated the efficacy and economic benefit of Cathflo Activase and a volume-dependent protocol versus a previously utilized fixed-dose 2 mg/mL alteplase aliquot protocol for central venous catheter clearance in pediatric patients. METHODS: All pediatric patients with a medically diagnosed catheter occlusion were eligible for inclusion into this study. Retrospective data was analyzed from an approved data collection form, which had been implemented during the utilization of the alteplase protocol. Data collection indicators included catheter type, dose, dwell time, outcome of attempt (successful or unsuccessful), additional measures taken, and comments. A new protocol utilizing Cathflo Activase and manufacturer recommended volume-based dosing was prospectively implemented and data was collected and evaluated and compared to data from the alteplase protocol. RESULTS: Alteplase and Cathflo protocol data was evaluated for a total of 96 courses in 48 patients (0.09 - 22.8 years, 2.15 - 105.2 kg). Complete resolution was achieved in 69.6% of patients with the alteplase protocol, partial resolution was attained in 8.7%, and treatment failure occurred in 21.7% of patients. For the Cathflo Activase group, complete resolution was observed in 82% of occlusions, with 8% partial resolution and treatment failure of 10%. The average cost per dose utilized by our patients during this study was $49.68 and $30.56 for the alteplase and Cathflo Activase groups, respectively. CONCLUSIONS: Our data indicate that the Cathflo Activase protocol may be as efficacious as the previous alteplase protocol. Furthermore, there are added time and cost benefits.
