1.
How I treat anemia in pregnancy: iron, cobalamin, and folate.
Achebe, MM, Gafter-Gvili, A
Blood. 2017;(8):940-949
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Abstract
Anemia of pregnancy, an important risk factor for fetal and maternal morbidity, is considered a global health problem, affecting almost 50% of pregnant women. In this article, diagnosis and management of iron, cobalamin, and folate deficiencies, the most frequent causes of anemia in pregnancy, are discussed. Three clinical cases are considered. Iron deficiency is the most common cause. Laboratory tests defining iron deficiency, the recognition of developmental delays and cognitive abnormalities in iron-deficient neonates, and literature addressing the efficacy and safety of IV iron in pregnancy are reviewed. An algorithm is proposed to help clinicians diagnose and treat iron deficiency, recommending oral iron in the first trimester and IV iron later. Association of folate deficiency with neural tube defects and impact of fortification programs are discussed. With increased obesity and bariatric surgery rates, prevalence of cobalamin deficiency in pregnancy is rising. Low maternal cobalamin may be associated with fetal growth retardation, fetal insulin resistance, and excess adiposity. The importance of treating cobalamin deficiency in pregnancy is considered. A case of malarial anemia emphasizes the complex relationship between iron deficiency, iron treatment, and malaria infection in endemic areas; the heightened impact of combined etiologies on anemia severity is highlighted.
2.
Updating practices in an evolving IV iron and anemia environment: practical solutions.
Amerling, R, Easom, A, Juergensen, P
Nephrology nursing journal : journal of the American Nephrology Nurses' Association. 2007;(5):533-41; quiz 542-3
Abstract
The latest considerations in the management of iron-deficiency anemia in patients on hemodialysis have centered on the updated guidelines and recommendations issued by the National Kidney Foundation, with interest on appropriate hemoglobin and serum ferritin targets. With practices evolving in the anemia environment, it is necessary for nurses to stay informed of new evidence-based data and practical solutions to improve patient outcomes. This underscores the importance of a team approach to managing anemia and balanced therapy with intravenous iron and erythropoiesis-stimulating agents. A symposium held during the 2007 annual meeting of the American Nephrology Nurses' Association addressed these issues. This article is based on the presentations and discussions from that symposium.
3.
Infection and inflammation in patients on dialysis: an underlying contributor to anemia and epoetin alfa hyporesponse.
Breiterman-White, R
Nephrology nursing journal : journal of the American Nephrology Nurses' Association. 2006;(3):319-22; quiz 323-4
Abstract
Acute or chronic infections or inflammatory conditions can exacerbate anemia in patients on dialysis. The primary goal is to identify and treat the underlying disorder, while minimizing the impact on hemoglobin (Hb) levels. Nurses can be instrumental in minimizing the impact of these conditions by monitoring the longitudinal trends in Hb levels, proactively assessing patients for inflammatory or infectious conditions, and intervening to resolve causative conditions and minimize the impact on anemia.
4.
Individualizing anaemia treatment: a discussion of case histories.
Muirhead, N
Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association. 2005;:vi37-43
Abstract
Current guidelines give evidence-based advice on how best to manage anaemia in patients with renal disease, but these guidelines do not consider individual patient needs, so tailoring anaemia management to each patient still remains a challenge for the treating physician. Two case studies are described that illustrate some of the key factors that need to be considered. The first case emphasizes that haemoglobin (Hb) targets recommended in current guidelines may not suit all patients. The patient had been stably maintained on subcutaneous epoetin therapy with an average Hb concentration of >13.0 g/dl because he developed angina symptoms when his Hb level fell to 12.2 g/dl. Iron deficiency was identified as the likely cause of falling Hb in this patient. After the patient's iron supplementation was increased, his Hb level was normalized back to >13.0 g/dl without increasing the epoetin dose, and the angina symptoms were resolved. The second case involved a pre-dialysis patient with diabetes, who required a higher dose of epoetin after beginning concomitant antihypertensive treatment with an angiotensin-converting enzyme inhibitor. Previously, the treatment of renal anaemia in pre-dialysis patients has not been the focus of attention. Two ongoing randomized controlled trials have been designed to study early initiation of epoetin treatment in pre-dialysis patients and will provide much needed information in this area.