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anemia (MACROCYTIC ANEMIA:MCV>100 (VitB12缺乏 (接受胃切除手術 (缺少胃分泌產生的內生性因子…

- - - - 缺少胃分泌產生的內生性因子 (intrinsic factor)
      - VitB12要和intrinsic factor結合才能被腸道吸收
  - - - 舉例:hydroxyurea for sickle cell disease, chemotherapeutic agents, and antiretroviral therapy (ART) in patients with HIV
- - - - Serum ferritin
        
        反映體內鐡質儲藏之多寡
        
        正常值40-200
      - Transferrin saturation (TSAT)
        
        *正常值20-50%
        
        計算:serum iron/TIBC
        
        使用鐵劑4hr內會增加血清鐵含量,可能會造成TSAT短暫上升*需注意抽血時間
      - Total iron-binding capacity (TIBC)
        
        正常值:300-360
- - - - 營養缺乏(folic acid/VitB12)
      - 骨髓內製造紅血球減少
      - hormone降低
        
        腎病
        
        hypothyroidism
        
        hypogonadism
    - - 原因:胃腸鐵吸收降低+巨噬細胞釋放鐵下降+EPO下降+RBC生命週期下降
    - - 出血/溶血
      - hypersplenism
  - - - is the packed spun volume of blood that consists of intact RBCs
      - 正常值:男40-50/女35-45
      - 計算:HCT = [RBC x MCV]/10
    - - 正常值:82-95
    - - 平均值:27-34
      - low MCH may be seen in iron deficiency and hemoglobinopathies like the thalassemias
    - - 計算:hemoglobin X 100 ÷ HCT
      - 正常值:32-36
      - 高度'降低:缺鐵性貧血/高度增加:遺傳性球形紅血球增多症或RBC凝集
    - - 正常值:11-14
    - - 正常值:男4.5-6/女4-5.2
    - - 正常值:男13.5-17.5/12-16
  - - - 成熟紅血球的前一步
      - 在大量紅血球流失狀況下，會提前自骨髓進入周邊血液
      - 正常值:0.5-2%/上升:溶血性貧血
- - - - iron
        
        常會因GI bleeding,抽血,透析導致缺鐵
        
        Adequate iron stores are essential for achieving optimal Hb levels and maximum benefit from ESA
        
        give loading dose of iron to all hemodialysis patients who have TSAT ≤20 percent and ferritin ≤200 ng/mL, regardless of the Hb and regardless of whether patients are treated with an ESA
        *對於透析病人不論是loading或是maintance都是IV給因為效果較PO好
      - ESA
        
        限制使用:Hb <10 g/dL+ not iron deficient
        
        SE:HTN
        
        劑量
        
        初始: 50 units/kg three times per week(較嚴重者可從100開始)
        
        Hb increase greater than 2.5 to 3 g/dL per month, ESA dose should be held or reduced by at least 50 percent.
        
        SC dose of ESA required to achieve a target Hb is 30 percent less than IV However, IV is favored for hemodialysis patients because SC is associated with greater discomfort and IV access is available for the dialysis treatment
        
        藥物
        
        darbepoetin (aranesp)
        
        QW
        
        MPGE(micera)
        
        Qmon給( long-acting, synthetic erythropoietin protein)
        
        epoetin (recormon)
        
        Initial dose: 20 I.U./kg TIW
        
        輸血
        
        適用:severe or symptomatic chronic anemia unresponsive to ESA and iron therapy
        
        目標:10-11(再高CV risk也跟著升高)
    - - 內容和透析差不多