maoudoody wrote:
this patient is suffering from chronic renal failure
so no erythropoeitin
give him erythropoeitin
before erythro nothing else would help him
becaiuse bone marrow wont respond
The fire's still on!!     
We are not sure that there is "NO E-POIETIN". E-poietin level declines as the renal damage progresses. There is no specified level of renal dysfunction at which you always have e-poietin deficiency anemia.
It can be Fe deficiency alone..
In terms of table, woods and carpenter..
Suppose we have 2 rooms (Room#1-Fe+epoitin def & room#1-Fe Def.alone).
We only know that there is no wood (Fe here) in both of them and there is no carpenter (epoietin) in one of them. Now, you want to build a table (for both the rooms if possible)
What will you buy first??
Wood or Carpenter?
 Please see the attachment.. I know its funny. But it was fun making it..
Attached Files:
A funny pic for Anemia in CRF.jpg (27 KB, 7 downloads)
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When a person really desires something, all the universe conspires to help him realize his dreams. - Paulo Coelho.
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| yogesh
Forum Newbie
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Posts: 56
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Ok I just found something very relevant.
This is what is written in HARRISON'S PRINCIPLES OF INTERNAL MEDICINE, 16th edition, p.1658.
"The iron status of the patient with CRD must be addressed and adequate iron stores should be available BEFORE!!!! treatment with EPO is initiated. Iron supplementation is usually essential to ensure an adequate response to EPO in patients with CRD because demands for iron by the erythroid marrow frequently exceed the amount of iron that is immediately available for erythropoiesis (as measured by percent transferrin saturation) as well as iron stores (as measured by serum transferrin). In most cases, intravenous iron is required to achieve and/or maintain adequate iron."
"... Blood transfusions may contribute to suppression of erythropoiesis in CRD; because they increase the risk of hepatitis, hemosiderosis and transplant sensitization, they should be avoided unless the anemia fails to respond to erythropoietin and the patient is symptomatic."
Now I know why there is no option for checking the iron status (with TIBC, %saturation, transferrin..etc). Because, even if this patient has adequate stores of iron (by lab reports), he still gets parenteral Iron (IV if possible) BEFORE EPO.
So next best step in the management would be... IV / IM iron. (It's not ..PO Fe+EPO, or EPO alone or measurement of transferrin or %sat. or blood transfusions..)
I am so happy..
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When a person really desires something, all the universe conspires to help him realize his dreams. - Paulo Coelho.
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| yogesh
Forum Newbie
Topics: 5
Posts: 56
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I apologize. Actually there is a specified limit. In stage-4 CRD, anemia due to EPO def is almost universal.. (Harrison's 16th.)
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When a person really desires something, all the universe conspires to help him realize his dreams. - Paulo Coelho.
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