Anemia

Ferriprox for sickle cell – pro

FERRIPROX® (deferiprone) is an iron chelator indicated for the treatment of patients with transfusional iron overload due to thalassemia syndromes when current chelation therapy is inadequate. The approval in second line is reasonable both because the studies for approval were done in second line and because Ferroprox may be inferior to Exjade in first line (Cemak et al). This is not an innocuous drug; the most serious side effect seen in about

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Cyclosporine for aplastic anemia – pro

Aplastic anemia in younger patients is generally immune mediated and is treated with immunosupression. When there is no sibling donor, cyclosporine(CSA) is recommended, usually in combination with other drugs but it can also be used alone(1). First-line treatment approaches include immunosuppressive treatment using the combination of antithymocyte globulin and cyclosporine A for patients without a sibling donor and HLA identical sibling transplant

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Erythropoietin therapy for cardiomyopathy – pro

Raising Hemoglobin levels is not always an unmitigated belssing. Studies in dialysis patients showed an increased risk of complications when Hb is raised above HB of 10-22.  Meta-analysis of reported randomized clincal trials(RCT)s conclude that normalization of hemoglobin with erythropoietin is harmful. The connection between heart failure(HF) and Hb levels appears to exist but it is not certain that low Hb worsens heart failure. Three studies

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Gastric bypass – pro

As weight loss begins to slow down after gastric bypass, the risk of nutritional problems increases. This is due to dysfunctional or bypassed small bowel. B12 and iron deficiency are two of the most common problems and often do not respond to typical multivitamin supplementation. Iron deficiency after gastric bypass is usually only seen in menstruating women or in patients who are actively and chronically bleeding. Ferritin or iron levels and erythrocyte

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Ferraheme, Ferrlecit or Venofer for iron deficency anemia – pro

As IV iron preparation have become safer, they are increasingly being used. However, the oral route is still best, when possible. Ferraheme is the latest IV iron entrant. Feraheme™ (ferumoxytol) Injection is indicated for the treatment of iron deficiency anemia in adult patients with chronic kidney disease (CKD). There are four commercially available i.v. iron products, iron dextran, iron sucrose, and iron ferric gluconate, or Ferrlecit and Ferraheme.

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Screening for hemachromatosis – pro

Current understanding of hemachormatosis incorporates the fact that some 30% of patients with familial occurrence of iron overload associated with C282Y homozygosity or C282Y/H63D compound heterozygosity never develop symptoms of the disease and this number is higher in menstruating females. It is also now appreciated that this is a disease with a long horizon before organ damage occurs and that close followup makes immediate diagnosis unnecessary

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Plasmapheresis in autoimmune hemolytic anemia – pro

Autoimmune hemolytic anemia (AIHA) due to the presence of warm agglutinins is almost always due to IgG antibodies that react with protein antigens on the red blood cell (RBC) surface at body temperature. For this reason, they are called "warm agglutinins" even though they seldom directly agglutinate the RBCs. IV Gammaglobulin blocks this process. I some cases, AIHA can be characterised by a chronic course and an unsatisfactory control of haemolysis,

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Procrit for anemia of Hepatitis C treatment – pro

Procrit is appropriate in the anemias due to erytrhopoietin underproduction or deficiency. In Hepatitis C it is usually both as well as due to chronic illness. Several studies have evaluated the use of recombinant human erythropoietin alfa (rHuEPO) (Procrit and Epogen) for the treatment of ribavirin/interferon-induced anemia in HCV-infected patients. In a letter to the editor of Hepatology, researchers in France reported the results of a study of

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Oxandrin and other androgens for Fanconi anemia – pro

Androgen steroids are male hormones that can stimulate the production of red blood cells (the cells which carry oxygen in the blood) and platelets (cells that help blood clot) and oxandrin is a more recenty approved androgen. Approximately half of FA patients respond well to androgens (male hormones), which stimulate the production of red blood cells, and often, platelets. Sometimes white cell production is stimulated as well. This treatment may

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Stem cell transplantation for Fanconi’s Anemia – pro

Fanconi anemia, or FA, is a rare, inherited blood disorder that leads to bone marrow failure. A variety of supportive treatments is available but stem cell transplantation is the only curative option (gene transfer therapies are still experimental).  The two year survival rate is around 70%. Alternative conditioning regimens using fludarabine and avoiding irradiation have shown promising results so far. For those patients without matched sibling

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