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Question for the group

claudia glamourcv at gmail.com
Mon Apr 3 06:55:12 BST 2006


Felix,

If the patient has high levels of inflammatory cytokines and is septic
or under inflammation secondary to trauma, hepcidin, a protein known
to interfere in iron absorption, will prevent any absorption from the
gastrintestinal tract with average iron sulphate and polidroxilated
iron. Ferrochelate is only slightly better (in Brazil - Neutrofer 500
mg - the equivalent of 4mg/kg of elemental iron daily). We don´t give
iron per oral route in inflammed patients.
However if the patient is anemic and needs erythropoietin, you need to
evaluate his iron stores, and iron metabolism through serum  ferritin,
serum iron, and transferrin saturation. If you have very low levels of
serum iron, and ferritin is low, that means that the patient might
benefit from intravenous iron supplementation.
However one must be aware that iron might impair phagocytosis and
saturate cells from phagocytic mononuclear lineage, increasing risks
of sepsis - so the ammount given must be the smallest needed to give
substrate for erythropoietin - not the full ammount to correct
completely the hemoglobin difference described in the products´
especifications. Erythropoietin doses are also to be higher than in
average schemes for renal patients since trauma and septic patients
usually are resistant to this hormone and already have high
circulating levels of endogenous erythropoietin - then doses must
start from 40000 units a week , if we are speaking of rHuepo,
epoietin. The responses shall be monitored with reticulocytes count 10
days after the beginning of therapy with iron - to see if the patient
is responding. Causes of blunted response are additional vitamin
deficiencies - B12, folate, piridoxin, overt inflammation, sepsis, low
thyroid hormone or suprarenal hormones levels,  drug induced marrow
depression and myelodysplastic alterations.
I usually perform folate and B12 serum dosage, besides ferrokinetics
tests. I don´t administer erythropoietin without being sure that there
is enough substrate for the marrow to work with.

Hope this helps

claudia

On 4/3/06, KMATTOX at aol.com <KMATTOX at aol.com> wrote:
> In a message dated 4/2/2006 9:59:05 P.M. Central Standard Time,
> felixalbers at terra.com.br writes:
>
> I have a  question for the group: in severe trauma patients, in ICU and
> already  stabilised but very anemic, do you supplement iron by IV route? I
> mean Hb
> >  7, enough to withold transfusion but still having suffered considerable
> blood  loss.
>
> No,  Give iron orally when the gut begins to work.   Might  also give
> erythropoetin
>
> k
>
>
>
>
>
> --
> trauma-list : TRAUMA.ORG
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