Anemia therapy

The goal of anemia therapy is to increase hemoglobin, which will improve red cell oxygen-carrying capacity, alleviate symptoms, and prevent anemia complications. 

The goal of anemia therapy is to increase the hemoglobin level, which will improve red cell oxygen-carrying capacity, alleviate symptoms, and prevent anemia complications. Normal hemoglobin values are 14 to 17.5 g/dL (140-175 g/L or 8.69-10.9 mmol/L) for males and 12.3 to 15.3 g/dL (123-153 g/L or 7.63-9.5 mmol/L) for females. It is important to note that... 

Studies have shown that in patients with chemotherapy-related anemia, therapy with erythropoietin products (epoetin-alfa and darbepoetin) can increase hemoglobin, decrease transfusion requirements, and improve quality of life.12 Epoetin is recombinant human erythropoietin, and darbepoetin is structurally similar to endogenous erythropoietin. Both bind to the same receptor to stimulate red blood cell production. Darbepoetin differs from epoetin in that it is a glycosylated form and exhibits a longer half-life in the body. The half-lives of a single subcutaneous injection of epoetin or darbepoetin in patients are roughly 27 and 43 hours, respectively. 

After treatment, patients should be monitored for symptom and laboratory value resolution, hemoglobin concentration, and adverse effects. The goal of anemia therapy is to correct the underlying source of the anemia, normalize the hemoglobin, and alleviate associated symptoms. 

George R. Miuot, William P. Murphy, George H. Whipple medicine, physiology discoveries concerning Hver therapy against anemias... 

Frequendy, the treatment of helminthic diseases requites adjunct medication. Allergic reactions are commonly seen as a result of tissue invasion by worms or as a consequence of anthelmintic therapy. Antihistamines and corticosteroids may be necessary adjuncts to therapy. Anemia, indigestion, and secondary bacterial infections can also occur and may requite concomitant therapy with hematopoietic drugs and appropriate antibiotics. 

Rare cases of hemolytic anemia, including fatalities, have been reported with the administration of the cephalosporins. The patient should be monitored for anemia If a patient experiences anemia within 2 to 3 weeks after the start of cephalosporin therapy, drug-induced anemia should be considered. If hemolytic anemia is suspected, the primary health care provider will discontinue the drug therapy. The patient may require blood transfusions to correct tire anemia. Frequent hematological studies may be required. 

Administration may result in nausea, vomiting, diarrhea, rash, anemia, leukopenia, and thrombocytopenia Signs of renal impairment include elevated blood urea nitrogen (BUN) and serum creatinine levels. Periodic renal function tests are usually performed during therapy. 

Discuss ways to promote an optimal response to therapy and important points to keep in mind when educating patients about the use of an agent used to treat anemia. 

The nurse assesses the patient for relief of the symptoms of anemia (fatigue, shortness of breath, sore tongue, headache, pallor). Some patients may note a relief of symptoms after a few days of therapy. Periodic laboratory tests are necessary to monitor the results of therapy. 

This drug is not used for treatment of severe anemia or as a substitute for emergency transfusion. However, supplemental iron maybe ordered during therapy with epoetin. 

Pernicious anemia—Lifetime therapy is necessary. Eat a balanced diet tiiat includes seafood, eggs, meats, and dairy products. Avoid contact with infections, and report any signs of infection to the primary health care provider immediately because an increase in dosage may be necessary. 

About 10% to 25% of patients treated with interferon and ribavirin require dosage reductions when hemoglobin levels decrease or they develop intolerable symptoms such as shortness of breath or severe fatigue. If warranted, erythropoietin may be used as adjunctive therapy for ribavirin-induced hemolytic anemia.45... 

Nonpharmacologic Therapy The incidence and severity of bleeding associated with uremia has decreased since dialysis has become the mainstay of treatment for ESRD. Dialysis initiation improves platelet function and reduces bleeding time.42 Improved care of the patient with ESRD, with anemia treatment and improvement in nutritional status, are also likely contributors to decreased uremic bleeding. 

Measure the treatment success for the various menstruation-related disorders by the degree to which the care plan (1) relieves or reverses symptoms of the disorder, (2) prevents or reverses the complications of the disorder (e.g., osteoporosis, anemia, and infertility), and (3) minimizes side effects. The return of a regular menstrual cycle with minimal premenstrual symptoms or symptoms of dysmenorrhea should occur. Depending on the desire for conception and subsequent therapy, this cycle may be ovulatory or anovulatory. 

Assess symptoms to determine if patient-directed therapy is appropriate (e.g., NSAIDs for dysmenorrhea) or whether the patient should be evaluated by a physician (e.g., amenorrhea, menorrhagia, anovulatory bleeding, or PMDD). Does the patient have any related complications, such as symptoms of anemia in patients presenting with menorrhagia or complaints of difficulty conceiving in women with amenorrhea or anovulatory bleeding. 

The underlying cause of anemia (e.g., blood loss iron, folic acid, or B12 deficiency or chronic disease) must be determined and used to guide therapy. 

In patients with iron-deficiency anemia, appropriate oral iron therapy that delivers sufficient elemental iron should be administered before giving parenteral iron. 

Therapy with epoetin or darbepoetin can increase hemoglobin, decrease transfusion requirements, and improve quality of life in cancer and kidney disease patients with anemia. 

The causes of anemia can be divided into three main categories decreased production, increased destruction, and blood loss. Drug therapy is the mainstay of treatment for anemias caused by reduced production of erythrocytes and will be the focus of this chapter. 

The underlying cause of anemia (e.g., blood loss iron, folic acid, or vitamin B12 deficiency or chronic disease) must be determined and used to guide therapy. As discussed previously, patients should be evaluated initially based on laboratory parameters to determine the etiology of the anemia (see Fig. 63-3). Subsequently, the appropriate pharmacologic treatment should be initiated based on the cause of anemia. 

Other than transfusion, nonpharmacologic therapy plays a limited role in the management of anemia. Certainly, some causes of anemia can be attributed to diets poor in iron, folic acid, or vitamin B12. However, in the United States, nutrient-poor diets are rarely the sole cause of anemia in a patient. Therefore, ingesting a diet that is rich in iron, folic acid, or vitamin B12 should be encouraged but should not be the only... 

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