Macrocytic anemia medical therapy: Difference between revisions
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__NOTOC__ | __NOTOC__ | ||
{{Macrocytic anemia}} | {{Macrocytic anemia}} | ||
{{CMG}}; {{AE}} | {{CMG}}; {{AE}}{{ADS}} | ||
==Overview== | ==Overview== | ||
[ | In deficiencies of vitamin b12 and folate causing megaloblastic anemia, supplementation are made with [[Cyanocobalamine]] and [[Folic Acid]] respectively based on the severity and the cause. | ||
==Medical Therapy== | ==Medical Therapy== | ||
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* '''Folate deficiency''' | * '''Folate deficiency''' | ||
** Parenteral regimen | ** Parenteral regimen | ||
*** Preferred regimen (1):[[Folic Acid]] 0.4-1 mg IV q 24h and maintenance doswe 0.4 mg q 24h<ref>{{cite book | last = DiPiro | first = Joseph | title = Pharmacotherapy : a pathophysiologic approach | publisher = McGraw-Hill Education | location = New York | year = 2017 | isbn = 9781259587481 }}</ref> | *** Preferred regimen (1):[[Folic Acid]] 0.4-1 mg IV q 24h and maintenance doswe 0.4 mg q 24h<ref name=":0">{{cite book | last = DiPiro | first = Joseph | title = Pharmacotherapy : a pathophysiologic approach | publisher = McGraw-Hill Education | location = New York | year = 2017 | isbn = 9781259587481 }}</ref> | ||
** Oral regimen | ** Oral regimen | ||
*** Preferred regimen (1): [[Folic Acid]] 1-5 mg PO q 24h<ref | *** Preferred regimen (1): [[Folic Acid]] 1-5 mg PO q 24h<ref name=":0" /> | ||
*** Alternative regimen (1): [[Folic Acid]] 1-15 mg PO q 24h<ref | *** Alternative regimen (1): [[Folic Acid]] 1-15 mg PO q 24h<ref name=":0" /> | ||
* [LDH]] falls in 2 days. [[Hypokalemia]] requiring replacement can occur in the acute phase as new cells are being generated rapidly. | * [[LDH]] falls in 2 days. [[Hypokalemia]] requiring replacement can occur in the acute phase as new cells are being generated rapidly. | ||
* A [[reticulocytosis]] begins in 3-5 days and peaks in 10 days. The HCT will rise within 10days. If it does not, suspect another disorder. Hypersegmented PMNs disappear in 10-14 days. | * A [[reticulocytosis]] begins in 3-5 days and peaks in 10 days. The HCT will rise within 10days. If it does not, suspect another disorder. Hypersegmented PMNs disappear in 10-14 days. | ||
* Neurologic abnormalities may take up to 6 months to resolve if ever. The longer the disease has been present, the worse is the prognosis for recovery. | * Neurologic abnormalities may take up to 6 months to resolve if ever. The longer the disease has been present, the worse is the prognosis for recovery. | ||
* Persons with PA have a | * Persons with PA have a twice risk of gastric cancer. Screen for occult blood. | ||
=====Contraindicated medications===== | =====Contraindicated medications===== | ||
Revision as of 21:43, 24 August 2018
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Amandeep Singh M.D.[2]
Overview
In deficiencies of vitamin b12 and folate causing megaloblastic anemia, supplementation are made with Cyanocobalamine and Folic Acid respectively based on the severity and the cause.
Medical Therapy
- Pharmacologic medical therapy is recommended among patients which don't improve on dietary measures.[1]
- Vitamin B12 deficiency
- Mild
- Parenteral regimen
- Preferred regimen (1): Cyanocobalamin 1000 μg IM q24h for 7 days, then q weekly for 4-8 weeks [1]
- Oral regimen
- Preferred regimen (1): Cyanocobalamin 500-1000 μg PO q24h[1]
- Parenteral regimen
- Severe
- Parenteral regimen
- Preferred regimen (1):Cyanocobalamin 1000 μg IM q24h for 7 days, then q weekly for 4-8 weeks [1]
- Oral regimen
- Preferred regimen (1): Cyanocobalamin1000-2000 μg PO q24h[1]
- Parenteral regimen
- Pernicious anemia
- Parenteral regimen
- Preferred regimen (1):Cyanocobalamin 1000 μg IM q24h for 7 days, then q weekly for 4-8 weeks [1]
- Alternative regimen (1): Cyanocobalamin 100-1000 μg IM q24h for 1-2 weeks and then 1-3 months[2]
- Oral regimen
- Preferred regimen (1): Cyanocobalamin1000-2000 μg PO q24h[1]
- Parenteral regimen
- Gastric bypass
- Parenteral regimen
- Preferred regimen (1):Cyanocobalamin 1000 μg IM or SQ q monthly[3]
- Alternative regimen (1): Cyanocobalamin 1000 μg IM q monthly[1]
- Oral regimen
- Preferred regimen (1): Cyanocobalamin 350-500μg PO q24h[3]
- Alternative regimen (1): Cyanocobalamin 1000-2000 μg PO q24h[1]
- Parenteral regimen
- Mild
- Folate deficiency
- Parenteral regimen
- Preferred regimen (1):Folic Acid 0.4-1 mg IV q 24h and maintenance doswe 0.4 mg q 24h[4]
- Oral regimen
- Preferred regimen (1): Folic Acid 1-5 mg PO q 24h[4]
- Alternative regimen (1): Folic Acid 1-15 mg PO q 24h[4]
- Parenteral regimen
- LDH falls in 2 days. Hypokalemia requiring replacement can occur in the acute phase as new cells are being generated rapidly.
- A reticulocytosis begins in 3-5 days and peaks in 10 days. The HCT will rise within 10days. If it does not, suspect another disorder. Hypersegmented PMNs disappear in 10-14 days.
- Neurologic abnormalities may take up to 6 months to resolve if ever. The longer the disease has been present, the worse is the prognosis for recovery.
- Persons with PA have a twice risk of gastric cancer. Screen for occult blood.
Contraindicated medications
Macrocytic Anemia is considered an absolute contraindication to the use of the following medications:
References
- ↑ 1.0 1.1 1.2 1.3 1.4 1.5 1.6 1.7 1.8 Stabler SP (January 2013). "Clinical practice. Vitamin B12 deficiency". N. Engl. J. Med. 368 (2): 149–60. doi:10.1056/NEJMcp1113996. PMID 23301732.
- ↑ Oh R, Brown DL (March 2003). "Vitamin B12 deficiency". Am Fam Physician. 67 (5): 979–86. PMID 12643357.
- ↑ 3.0 3.1 Parrott J, Frank L, Rabena R, Craggs-Dino L, Isom KA, Greiman L (May 2017). "American Society for Metabolic and Bariatric Surgery Integrated Health Nutritional Guidelines for the Surgical Weight Loss Patient 2016 Update: Micronutrients". Surg Obes Relat Dis. 13 (5): 727–741. doi:10.1016/j.soard.2016.12.018. PMID 28392254.
- ↑ 4.0 4.1 4.2 DiPiro, Joseph (2017). Pharmacotherapy : a pathophysiologic approach. New York: McGraw-Hill Education. ISBN 9781259587481.