Macrocytic anemia medical therapy: Difference between revisions
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==Overview== | ==Overview== | ||
[Therapy] is recommended among all patients who develop [disease name]. | [Therapy] is recommended among all patients who develop [disease name]. | ||
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==Medical Therapy== | ==Medical Therapy== | ||
*Pharmacologic medical therapy is recommended among patients | *Pharmacologic medical therapy is recommended among patients which don't improve on dietary measures.<ref name="pmid23301732">{{cite journal |vauthors=Stabler SP |title=Clinical practice. Vitamin B12 deficiency |journal=N. Engl. J. Med. |volume=368 |issue=2 |pages=149–60 |date=January 2013 |pmid=23301732 |doi=10.1056/NEJMcp1113996 |url=}}</ref> | ||
=== | |||
* ''' | * '''Vitamin B12 deficiency''' | ||
** | ** '''Mild''' | ||
**** Parenteral regimen | **** Parenteral regimen | ||
***** Preferred regimen (1): [[ | ***** Preferred regimen (1): [[Cyanocobalamin Injection|Cyanocobalamin]] 1000 μg IM q24h for 7 days, then q weekly for 4-8 weeks <ref name="pmid23301732" /> | ||
**** Oral regimen | **** Oral regimen | ||
***** Preferred regimen (1): [[ | ***** Preferred regimen (1): [[Cyanocobalamin Injection|Cyanocobalamin]] 500-1000 μg PO q24h<ref name="pmid23301732" /> | ||
*** '''Severe''' | |||
*** | |||
**** Parenteral regimen | **** Parenteral regimen | ||
***** Preferred regimen (1): [[ | ***** Preferred regimen (1):[[Cyanocobalamin Injection|Cyanocobalamin]] 1000 μg IM q24h for 7 days, then q weekly for 4-8 weeks <ref name="pmid23301732" /><nowiki/> | ||
**** Oral regimen | **** Oral regimen | ||
***** Preferred regimen (1): | ***** Preferred regimen (1): [[Cyanocobalamin Injection|Cyanocobalamin]]1000-2000 μg PO q24h<ref name="pmid23301732" /> | ||
** | |||
*** '''Pernicious anemia''' | |||
** | |||
*** | |||
**** Parenteral regimen | **** Parenteral regimen | ||
***** Preferred regimen (1): [[ | ***** Preferred regimen (1):[[Cyanocobalamin Injection|Cyanocobalamin]] 1000 μg IM q24h for 7 days, then q weekly for 4-8 weeks <ref name="pmid23301732" /> | ||
***** Alternative regimen (1): [[ | ***** Alternative regimen (1): [[Cyanocobalamin Injection|Cyanocobalamin]] 100-1000 μg IM q24h for 1-2 weeks and then 1-3 months<ref name="pmid12643357">{{cite journal |vauthors=Oh R, Brown DL |title=Vitamin B12 deficiency |journal=Am Fam Physician |volume=67 |issue=5 |pages=979–86 |date=March 2003 |pmid=12643357 |doi= |url=}}</ref> | ||
**** Oral regimen | **** Oral regimen | ||
***** Preferred regimen (1): [[ | ***** Preferred regimen (1): [[Cyanocobalamin Injection|Cyanocobalamin]]1000-2000 μg PO q24h<ref name="pmid23301732" /> | ||
* | |||
*** '''Gastric bypass''' | |||
* | |||
*** | |||
**** Parenteral regimen | **** Parenteral regimen | ||
***** Preferred regimen (1): [[ | ***** Preferred regimen (1):[[Cyanocobalamin Injection|Cyanocobalamin]] 1000 μg IM or SQ q monthly<ref name="pmid28392254">{{cite journal |vauthors=Parrott J, Frank L, Rabena R, Craggs-Dino L, Isom KA, Greiman L |title=American Society for Metabolic and Bariatric Surgery Integrated Health Nutritional Guidelines for the Surgical Weight Loss Patient 2016 Update: Micronutrients |journal=Surg Obes Relat Dis |volume=13 |issue=5 |pages=727–741 |date=May 2017 |pmid=28392254 |doi=10.1016/j.soard.2016.12.018 |url=}}</ref> | ||
***** Alternative regimen (1): [[Cyanocobalamin Injection|Cyanocobalamin]] 1000 μg IM q monthly<ref name="pmid23301732" /> | |||
***** Alternative regimen ( | |||
**** Oral regimen | **** Oral regimen | ||
***** Preferred regimen (1): [[drug name]] 50 mg/kg/day PO q8h for 14 (14–21) days (maximum, 500 mg per dose) | ***** Preferred regimen (1): [[Cyanocobalamin Injection|Cyanocobalamin]] 350-500μg PO q24h<ref name="pmid28392254" /> | ||
***** Alternative regimen (1): [[Cyanocobalamin Injection|Cyanocobalamin]] 1000-2000 μg PO q24h<ref name="pmid23301732" /> '''Pediatric''' | |||
** Parenteral regimen | |||
*** Preferred regimen (1): [[drug name]] 50–75 mg/kg IV q24h for 14 (14–21) days (maximum, 2 g) | |||
*** Alternative regimen (1): [[drug name]] 150–200 mg/kg/day IV q6–8h for 14 (14–21) days (maximum, 6 g per day) | |||
*** Alternative regimen (2): [[drug name]] 200,000–400,000 U/kg/day IV q4h for 14 (14–21) days (maximum, 18–24 million U per day) | |||
** Oral regimen | |||
*** Preferred regimen (1): [[drug name]] 50 mg/kg/day PO q8h for 14 (14–21) days (maximum, 500 mg per dose) | |||
* | * | ||
* [[Folate]] is administered 1mg QD. Higher doses may be required in malabsorptive syndromes. It is empirically given to those with SCD and those on HD. | * [[Folate]] is administered 1mg QD. Higher doses may be required in malabsorptive syndromes. It is empirically given to those with SCD and those on HD. |
Revision as of 21:21, 24 August 2018
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:
Overview
[Therapy] is recommended among all patients who develop [disease name].
OR
Pharmacologic medical therapy is recommended among patients with [disease subclass 1], [disease subclass 2], and [disease subclass 3].
OR
Pharmacologic medical therapies for [disease name] include (either) [therapy 1], [therapy 2], and/or [therapy 3].
OR
Empiric therapy for [disease name] depends on [disease factor 1] and [disease factor 2].
OR
Patients with [disease subclass 1] are treated with [therapy 1], whereas patients with [disease subclass 2] are treated with [therapy 2].
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
- Pernicious anemia
-
- 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] Pediatric
- Parenteral regimen
- Gastric bypass
- Parenteral regimen
- Preferred regimen (1): drug name 50–75 mg/kg IV q24h for 14 (14–21) days (maximum, 2 g)
- Alternative regimen (1): drug name 150–200 mg/kg/day IV q6–8h for 14 (14–21) days (maximum, 6 g per day)
- Alternative regimen (2): drug name 200,000–400,000 U/kg/day IV q4h for 14 (14–21) days (maximum, 18–24 million U per day)
- Oral regimen
- Preferred regimen (1): drug name 50 mg/kg/day PO q8h for 14 (14–21) days (maximum, 500 mg per dose)
- Folate is administered 1mg QD. Higher doses may be required in malabsorptive syndromes. It is empirically given to those with SCD and those on HD.
- B12 must be given as a load then maintenance. Most advocate 1000 mcg IM Qweek x4 then 100mcg/month.
- [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 2x risk of gastric CA (in some studies). 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.