頁籤選單縮合
題名 | Response of Uremic Anemia to High Dose Iron Supplementation=尿毒性貧血對補足鐵之後的反應 |
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作者 | 黃志強; 陳建安; 林建任; 王嬋婷; Hwang, Jyh-chang; Chen, Jen-an; Lin, Jiann-renn; Wang, Charn-tyng; |
期刊 | 中華民國腎臟醫學會雜誌 |
出版日期 | 19970300 |
卷期 | 11:1 1997.03[民86.03] |
頁次 | 頁27-33+53 |
分類號 | 415.513 |
語文 | eng |
關鍵詞 | 尿毒性貧血; 鐵; Anemia; Ferritin; Uremia; Iron therapy; Erythropoietin; thalassemia; |
英文摘要 | To evaluate the response of uremic anemia to high dose iron supplements from February to June 1995, we intravenously infused iron dextran 1000 mg per month to all patients in our center (n=210) to keep serum ferritin levels above 1000 ng/ml. In February, 67.6% of patients had normocytic normochromic anemia. This declined to 52.9% in April, and rose again to 62.4% in June. The prevalence of macrocytic anemia markedly increased from 15.7% in February to 43.3% in April after iron repletion, while microcytic anemia decreased sharply from 16.7% to 3.8%, mildly elevating to 5.2% in June. There was still a positive correlation (r=0.52, p<0.001) between mean corpuscular volume (MCV) and transferrin saturation (TS) in February with a TS of 31.1% and a serum ferritin level (Fe) of 826.2ng/ml, but the correlation disappeared almost completely after high dose iron supplements ini April (r=0.16, p<0.001) and June (r=0.20, p<0.01). The difference in iron stores categorized by red cell size in each group was ameliorated after microcytic anemia was suppressed to about 5% by iron replacements, and all the patients in the microcytic group were proved have thalassemia. High dose iron supplements did not significantly interfere with the serum iron level (SI) but they suppressed the total iron binding capacity (TIBC) to subnormal levels (<260ug/dl), with a resulting increment of TS. Simply replenishing iron stores from February to March under the same recombinant human erythropoiein (r-huEPO) dosage significantly elevated the serum albumin and hematocrit (Hct) and MCV in the April data. In conclusion: We proved it is safe to keep the serum ferritin level above 1000ng/ml for 5 months in uremic patients. The variation in iron status modified only the percentages of macrocytic and microcytic, but not of normocytic anemia. The risk of iron inadequacy was increased if the prevalence of microcytic anemia was higher than 5%. Only about 70% of uremic patients require r-huEPO at a dosage of 4000U/week to achieve target Hct of 30% after complete exclusion exclusion of iron depletion. |
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