ABSTRACT
WHAT IS KNOWN AND OBJECTIVE: In the management of anaemia associated with chronic kidney disease (CKD), optimal use of intravenous (i.v.) iron has a central role. It minimizes reliance on erythropoiesis-stimulating agents (ESAs) and may be beneficial in reducing overall cardiovascular risks through its effects on platelet counts (PLT). We have examined the effects of i.v. iron on PLT in patients with CKD. METHODS: Two hundred and three patients with CKD, referred to a single teaching hospital in UK for i.v. iron therapy, received low molecular-weight iron dextran at a median dose of 1000 milligrams given over a median time of 2 h and 40 min. PLT at baseline were compared with the measurements taken during a 4-month follow-up period post-infusion. RESULTS: PLT were checked at various points following i.v. iron treatment. Compared with baseline, mean reduction in PLT ranged between 10.1 and 23.6 (×10(9) /L) during consecutive 15-days intervals post-treatment. At the reference point of 90-days post-infusion, the drop in PLT was statistically significant (P < 0.001). WHAT IS NEW AND CONCLUSION: Low molecular-weight iron dextran in patients with CKD leads to reduction in PLT. This reduction appears soon after treatment and is maximal after 3 months. Prospective data are required to confirm these findings and examine whether this translates to a reduction in thrombotic episodes.
Subject(s)
Anemia, Iron-Deficiency/blood , Anemia, Iron-Deficiency/drug therapy , Iron/administration & dosage , Platelet Count , Renal Insufficiency, Chronic/blood , Administration, Intravenous , Adolescent , Adult , Aged , Aged, 80 and over , Anemia, Iron-Deficiency/etiology , Female , Follow-Up Studies , Humans , Male , Middle Aged , Platelet Count/methods , Renal Insufficiency, Chronic/complications , Retrospective Studies , United Kingdom , Young AdultABSTRACT
Renal transplant recipients are at high risk of developing opportunistic infections particularly in the first 6 months after transplantation. Organisms causing such infections include rapidly growing non-tuberculous mycobacteria (NTM). Lymphocytes have a central role in combating mycobacterial infections. The use of lymphocyte-depleting agents, such as alemtuzumab, in the renal transplant population has increased in recent years. A case of multifocal osteomyelitis caused by one of the NTM, Mycobacterium chelonae, in a renal transplant recipient, after alemtuzumab induction, is presented.
Subject(s)
Antibodies, Monoclonal, Humanized/adverse effects , Bone Diseases, Infectious/diagnostic imaging , Immunosuppressive Agents/adverse effects , Kidney Transplantation/adverse effects , Mycobacterium Infections, Nontuberculous/chemically induced , Mycobacterium chelonae , Opportunistic Infections/chemically induced , Alemtuzumab , Antitubercular Agents/therapeutic use , Bone Diseases, Infectious/microbiology , Humans , Male , Middle Aged , Mycobacterium Infections, Nontuberculous/drug therapy , Mycobacterium Infections, Nontuberculous/microbiology , Opportunistic Infections/microbiology , RadiographyABSTRACT
In patients with chronic digoxin toxicity, especially in the presence of renal impairment, a prolonged duration of continuous monitoring is required with consideration given to further doses of immune fab if necessary for re-emergence of toxicity.