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Question for the group

claudia glamourcv at gmail.com
Mon Apr 3 07:24:25 BST 2006


I wish I could...:-)

claudia

On 4/3/06, Felix Albers <felixalbers at terra.com.br> wrote:
> oh boy,
>
> this girl rules
>
> Felix.
>
> ----- Original Message -----
> From: "claudia" <glamourcv at gmail.com>
> To: "Trauma &amp, Critical Care mailing list" <trauma-list at trauma.org>
> Sent: Monday, April 03, 2006 2:55 AM
> Subject: Re: Question for the group
>
>
> 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
> >
> >
> >
> >
> >
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