Anaemia treatment

Goldsmith D, Covic A. Time to Reconsider Evidence for Anaemia Treatment (TREAT) = Essential Safety Arguments (ESA). Nephrol Dial Transplant 2010 25 (6) 1734-7. 

Erythropoietin 166 amino acids glycosylated Mammalian cells Treatment of anaemia associated with dialysis and AZT/AIDS Approved for sale Without glycosylation protein is cleared very quickly from plasma... 

Iron dextran injection contains a complex of iron hydroxide with dextrans of average molecular weight between 5000 and 7000, and is used for the treatment of iron-defieiency anaemia in situations where oral therapy is ineffeetive or impractical. The sodium salt of sulphurie aeid esters of dextran, i.e. dextran sodium sulphate, has anti-eoagulant properties eomparable with heparin and is formulated as an injection for intravenous use. 

Cyanocobalamin (vitamin B12) Propionibacterium freudenreichii Propionibacterium shermanii Pseudomonas denitriTicans Treatment of pernicious anaemia... 

The most popular bioassay of EPO involves a mouse-based bioassay (EPO stimulates red blood cell production, making it useful in the treatment of certain forms of anaemia Chapter 10). Basically, the EPO-containing sample is administered to mice along with radioactive iron (57Fe). Subsequent measurement of the rate of incorporation of radioactivity into proliferating red blood cells is undertaken. (The greater the stimulation of red blood cell proliferation, the more iron taken up for haemoglobin synthesis.)... 

Neorecormon (tradename, also known as epoetin beta) is a recombinant human EPO first approved for medical use in the EU in 1997. It is indicated for the treatment of anaemia associated with various medical conditions, most commonly chronic renal failure and cancer patients receiving chemotherapy. Neorecormon is produced by recombinant DNA technology in a CHO cell line and is manufactured as outlined in Figure 10.5. It is presented in lyophilized format at various strengths (500-10 000 IU/vial) and contains phosphate buffer, sodium chloride, calcium chloride, urea, polysorbate and various amino acids as excipients. 

The product displays a terminal half-life of 4-12 h and 8-22 h after i.v. and s.c. administration respectively. Dosage regime is dependent upon the exact disease condition, but generally involves administration once/several times weekly. Various clinical trials investigating various indications proved product efficacy in the treatment and prevention of anaemia, with increased haemocrit values observed. 

EPO was first used therapeutically in 1989 for the treatment of anaemia associated with chronic kidney failure. This anaemia is largely caused by insufficient endogenous EPO production by the diseased kidneys. Prior to EPO approval this condition could only be treated by direct blood transfusion. It responds well, and in a dose-dependent manner, to the administration of recombinant human EPO (rhEPO). The administration of EPO is effective, both in the case of patients receiving dialysis and those who have not yet received this treatment. 

Treatment of anaemia associated with chronic disease Treatment of anaemia associated with cancer/chemotherapy Treatment of anaemia associated with prematurity To facilitate autologous blood donations before surgery To reduce transfusion requirements after surgery To prevent anaemia after bone marrow transplantation... 

Severe, and in particular chronic, infection can also sometimes induce anaemia, which is often made worse by drugs used to combat the infection. For example, anaemia is evident in 8 per cent of patients with asymptomatic HIV infection. This incidence increases to 20 per cent for those with AIDS-related complex, and is greater than 60 per cent for patients who have developed Kaposi s sarcoma. Up to a third of AIDS patients treated with zidovudine also develop anaemia. Again, several trials have confirmed that EPO treatment of AIDS sufferers (be they receiving zidovudine or not) can increase haematocrit values and decrease transfusion requirements. 

Anxiety is common among the elderly but the literature regarding the assessment, diagnosis, and treatment of these illnesses in older individuals is sparse (Blazer 1997). Most often anxiety does not present for the first time in late life. If that is the case one should suspect an underlying condition or other external cause. These causes could be medications such as digitalis, antipsychotics but also conditions as anaemia, chronic obstructive lung disease with hypoxia or myocardial infarction. 

Arsenic is highly toxic, and indeed much speculation has surrounded arsenic poisoning as the cause of death of Napoleon Bonaparte, on account of the levels of As in the Emperor s hair (perhaps derived from fungal activity on a green pigment present in the wallpaper of his apartments in St. Helena). Arsenic trioxide has been approved by the Food and Drug Administration (FDA) of the USA for the treatment of acute promyelocytic anaemia in adult patients who fail to respond to other chemotherapy, or have relapsed disease. 

Most importantly, the determination of cortisol levels is considered useful in the diagnosis and treatment of various ailments, namely Addison s Disease i.e., pernicious anaemia—a condition whereby the maturation of the red cells may not proceed beyond the stage of megaloblasts Cushing s Syndrome. 

Lastly, nomifensine was an interesting antidepressant that also had noradrenaline, dopamine and, due to its 4-hydroxy metabolite, serotonin reuptake properties. It was withdrawn some years ago because of the occurrence of haemolytic anaemia in a small number of patients. It was a particularly effective drug in the treatment of depression in patients with epilepsy as, unlike many antidepressants available at that time, it did not affect the seizure threshold. 

Side-effects of corbamazepine include blood disorders such as thrombocytopenia, leucopenia, aplastic anaemia and agranulocytosis. Patients ore therefore advised to stop treatment and contact a healthcare provider if they develop symptoms of sore throat, fever, rash, mouth ulcers, bleeding or bruising. 

Cys i replaced by Ser) mahgnant skin tumours and in the treatment of aplastic anaemia and myelodysplastic syndrome... 

There is a number of synthetic substitutes for natural ferritin and the properties of these have been compared with those of ferritin. The synthetic polysaccharide iron complex (PIC), has a magnetic blocking temperature of 48K (Mohie-Eldin et al. 1994). Iron-dextran complexes are used as a substitute for ferritin in the treatment of anaemia. The iron cores of these complexes consist not of ferrihydrite, but of very poorly crystalline akaganeite with magnetic blocking temperatures of between 150 and 290 K (Muller, 1967 Knight et al. 1999) which were lowered from 55K to 35 and 25K, if prepared in the presence of 0.250 and 0.284 Al/(A1 -i- Fe), respectively (Cheng et al.2001). 

Procrit (Amgen/Johnson Johnson) Erythropoietin (treatment of anaemia) 2.7... 

Bone marrow transplantation, particularly allogenic transplantation, is often a treatment of choice for individuals suffering from acute or chronic leukaemia, aplastic anaemia or various stem cell-related genetic disorders (e.g. thalassaemias). 

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