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Exam (elaborations) TOEFL
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3. ANEMIA OF CHRONIC DISEASE (INFLAMMATORY ANEMIA) - CORRECTANSWER-
Treatment of Anemia of Chronic Disease (ACD)
- Why treat?
- associated with __________ prognosis, particularly in patients with
__________________, _____________________________ and/or
______________________
- treatment options
management of ________________________________
______________________ agents
________ supplementation if concomitant IDA
________ transfusions - CORRECT ANSWER-Treatment of Anemia of Chronic
Disease (ACD)
- Why treat?
- associated with poor prognosis, particularly in patients with malignancy, chronic kidney
disease and/or heart failure
- treatment options
management of underlying conditions
erthropoietic agents
iron supplementation if concomitant IDA
RBC transfusions
Treatment of ACD: Erythropoietic Stimulating Agents (ESAs)
short term benefits
- correction of _____________
- avoidance of ____________________________ - CORRECT ANSWER-Treatment of
ACD: Erythropoietic Stimulating Agents (ESAs)
short term benefits
- correction of anemia
- avoidance of RBC transfusions
- goal for use of ESAs in CKD:
- patients with ND-CKD hgb >=10 :
- patients with ND-CKD hgb < 10 :
- patients with 5D-CKD (stage 5 CKD with dialysis) : - CORRECT ANSWER-- benefits
of avoiding transfusions and ESA side effects (stroke, vascular access loss)
- don't initiate ESA
- individualize the decision to initiate ESA based on Hgb
- if Hgb is 9-10, use ESA to avoid Hgb falling below 9
ESAs for Treatment of Anemia of CKD
- synthetic recombinant human _______________________
- goal: avoid/minimize need for ____________________________; this is a chronic
condition
, - ESA not shown to significantly or consistently improve ___________, quality of life or
overall patient well being
- available formulations
1)
2)
- monitoring: - CORRECT ANSWER-ESAs for Treatment of Anemia of CKD
- synthetic recombinant human erythropoietin
- goal: avoid/minimize need for RBC transfusions; this is a chronic condition
- ESA not shown to significantly or consistently improve fatigue, quality of life or overal
patient well being
- available formulations
1) epoetin alfa
2) darbopoetin alfa
- monitoring: monthly Hgb
ESA Initiation and Dosing
1) initiate ESA
- HD-CKD and PD-CKD:
- ND-CKD:
2) reduce/stop ESA
- HD-CKD and PD-CKD:
- ND-CKD:
3) Epoetin alfa dosing HD-CKD and PD-CKD: IV or SubQ
Epoetin alfa dosing ND-CKD: IV or SubQ
4) Darbepoetin alfa dosing
- HD-CKD and PD-CKD: IV or SubQ
- ND-CKD: IV or SubQ - CORRECT ANSWER-ESA Initiation and Dosing
1) initiate ESA
- HD-CKD and PD-CKD: Hgb < 10 g/dL
- ND-CKD: Consider if Hgb < 10 g/dL - only use if rate of Hgb decline would result in
transfusion
2) reduce/stop ESA
- HD-CKD and PD-CKD: Hgb approaches or exceeds 11 g/dL
- ND-CKD: Hgb exceeds 10 g/dL
3) Epoetin alfa dosing HD-CKD and PD-CKD: IV
Epoetin alfa dosing ND-CKD: IV or SubQ
4) Darbepoetin alfa dosing
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