Guidelines for anemia in H/D patients

Guidelines for anemia in H/D patients
Vs 林信昌
R4 曾黃泱
Guideline 1 Targets:
Target Hematocrit for EPO Therapy:
The target for hematocrit is 33~34%
Target Iron Level:
TSAT 30%
Ferritin level 300 ng/mL
TSAT >50% and/or ferritin level >500 ng/ml  Stop iron administration
Guideline 2 When to initiation of iron supplementation:
If TSAT is >30% and the serum Ferritin is >300 ng/mL and Hct <33%
 800mg IV iron given over 10 weeks.
 no increase in Hct and no increase in serum ferritin and TSAT level at
the same dose of EPO, a second course of IV iron should be tried.
 no increase in Hct, but either the TSAT or serum ferritin level
increases, then the weekly dose of IV iron should be reduced to the lowest
amount to maintain the TSAT >30% and serum ferritin at >300 ng/mL.
If increase in Hct at a constant dose of EPO, or a stable Hct at a decreased
dose of EPO,
 Administering 800mg of iron IV over 8 to 10 weeks again to achieve
and maintain the Hct 33%.
Guideline 3 Monitoring Iron Status:
A. In the initiation of EPO therapy and adjusting the EPO dose, the
TSAT and Ferritin should be checked every 3 months until target Hct is
B. Following attainment of the target Hct, TSAT and serum ferritin
should be determined every 3 months.
Guideline 4 Intravenous iron given schedules:
If the TSAT remains <30% and/or ferritin <300 ng/mL, IV iron with
80mg per week for 8 to 10 wks.
Once the patient’s TSAT is >30% and ferritin is >300 ng/mL(Target), IV
iron with 40mg once per week.
In patients in whom TSAT is >50% and/or ferritin is >500 ng/mL, IV iron
held for 3 months and the iron parameters should be re-measured before
IV iron is resumed.
The maintenance iron status: measuring the TSAT and ferritin every 3
Guideline 5 Intravenous EPO given schedules:
Guideline 6 RBC Transfusions in H/D Patients:
RBC transfusions are indicated in:
A. Hct < 20%
B. Hct < 24% + Recognized symptoms or signs due to anemia.
C. The Epoetin-resistant patient who has chronic blood loss