Case study of the anemic patient: epoetin alfa--focus on iron management.

Optimal maintenance of iron status is the keystone to sustaining normal erythrocyte production and function. Despite ongoing educational efforts for health care professionals and patients, iron management remains a challenge for clinicians managing patients who receive Epoetin alfa therapy. This article illustrates how to use a protocol to improve iron management in these patients; two case studies provide examples of the clinical application of the protocol.

Case management of the anemic patient: epoetin alfa--focus on iron supplementation.

Epoetin alfa stimulates erythropoiesis, thus creating an increased need for iron, and virtually all patients with end-stage renal disease who receive this therapy will eventually require iron supplementation. This article describes the appropriate use of oral and intravenous iron supplementation, including patient assessment, education, and management.

Case management of the anemic patient. Epoetin alfa: focus on iron management.

Stimulation of erythropoiesis by Epoetin alfa causes an increased demand for iron to facilitate hemoglobin synthesis. This article outlines how nephrology nurses can monitor and manage iron levels during Epoetin alfa therapy; including both iron-deficient and iron overloaded patients.

Iron status in patients receiving erythropoietin for dialysis-associated anemia.

Adequate body iron stores are crucial to assuring rapid and complete response to recombinant human erythropoietin (rHuEPO). In the present study, markers of iron storage were examined in 27 patients with normochromic, normocytic anemia undergoing acute rHuEPO (150 to 300 U/kg t.i.w.) treatment for anemia. We calculated projected iron needed for new hemoglobin synthesis from the difference between initial and target hemoglobin concentrations, initial iron reserves available from initial serum ferritin levels, and net projected surplus or deficit from the difference between needs and reserves. Of 22 patients predicted to develop iron deficiency (mean projected deficit 268 +/- 70 mg), 20 developed evidence of exhausted iron stores (transferrin %sat less than 16 or ferritin less than 30 micrograms/liter) before reaching target hemoglobin; two predicted to become deficient (projected deficit less than 100 mg) did not; and all five predicted to avoid iron deficiency (mean projected surplus 177 +/- 20 mg) remained iron replete. During acute rHuEPO therapy net body iron balance remained neutral in patients receiving no iron supplements and increased 5 mg/kg in patients prescribed oral ferrous sulfate. However, in patients given iron dextran i.v. less than 60% of elemental iron administered became measurable as iron stores or usable for hemoglobin synthesis.