Anemia/Sickle Cell [Trovinger] Flashcards
Oral Iron Supplementation
Ferrous sulfate 325 mg [20% elemental iron] PO every OTHER day
take Iron _____ food
WITHOUT– best to take one hour before breakfast
If GI distress– can take with food
IV iron
ONLY use if cannot tolerate PO
Allergic reactions and infection risk
IV Iron dosing
Women: [(12-HGB) x lb] + 600
Men: [(14-HGB) x lb] + 1000
Folic Acid Dosing
1-5 mg PO Qday
B12 Dosing
1000 mcg Qday
may start with IM/SQ for one week and then switch to PO if patient experiencing severe symptoms
B12 ___-soluble so you CAN/CANNOT overdose on them
WATER
CANNOT
Infants
iron needed for mental function – exclusively breastfed infants should be supplemented 1 mg/kg/day starting at 4 months until eating an iron-sufficient diet
Iron CAN/CANNOT be overdosed
CAN
Sickle Cell goals of therapy
reduce hospitalizations, mortality, complications
improve QoL
Hydroxyurea
only in children greater than 6 months old
15 mg/kg/day
Monitor CBC q2 weeks –> if acceptable can increase by 5 mg/kg/day until max tolerated or 35 mg/kg/day
clinical response: 3-6 months
adherence is HUGE – t1/2 only 2-4 hours
Glutamine
<30 kg: 10 g/day
30-65 kg: 20 g/day
>65 kg: 30 g/day
*give in 2 divided doses; comes in 5g packets– each 5 oz mixed into 8 oz fluid or 4-6 oz food
ADE: constipation, nausea, bloating
Crizanlizumab
16 years or older
5 mg/kg IV q2 weeks x 2
5 mg/kg IV q4 weeks thereafter
can be used with or without hydroxyurea
30 min infusion
Voxelotor
12 years or older
1.5 g PO daily
can be used with or without hydroxyurea
dosing adjustment needed in severe hepatic impairment
Fevers in Sickle Cell patients:
very dangerous
> 101.3 need medical attention ASAP
