losartan-potassium and Anaphylaxis

Derangements of iron metabolism may be present in critically ill patients who develop anemia during a stay in the intensive care unit. Iron supplementation may be appropriate, especially if an underlying nutritional disorder is present. It may be even more critical to replace iron when erythropoietin therapy is used because of the consumption of iron stores that occurs during heme synthesis. Iron therapy is not without risks, and controversy persists regarding the potential for iron overload and infections. Clinical trials that define the optimal dose, route, and timing of iron administration in critically ill patients are lacking. However, studies of iron supplementation in chronic kidney disease, pregnancy, and anemia of prematurity may provide some guidance about approaches to treatment. Clinical evidence and limitations that can assist clinicians in managing iron therapy in the intensive care unit are presented.

Topics: Administration, Oral; Adult; Anaphylaxis; Anemia; Chronic Disease; Critical Care; Dietary Supplements; Erythroblasts; Erythropoietin; Female; Humans; Infant; Infant Care; Infant, Newborn; Infant, Premature; Iron; Iron-Dextran Complex; Kidney Diseases; Pregnancy

Allogenic blood transfusion may be required for the treatment of anemia due to a hematologic disease, the consequences of chemotherapy or other circumstances, such as haemorrage and/or surgery. Transfusion becomes indispensable to prevent the side effects of anemia, such as hypoxia, palpitations, tachycardia, cardiac ischemia and fatigue. However, frequent transfusions can cause several acute problems such as hemolysis, anaphylactic shock and septic shock but also chronic problems such as iron overload (hemochromatosis), alloimmunisation and metabolic disturbances. Each of these complications can produce serious consequences and could even be sometimes fatal. Therefore we should recognise, prevent and if necessary treat all these hazards. Our article emphasises the potential chronic problems. For hemochromatosis, an iron chelator (deferoxamine) should be administered. In the presence of allo-immunisation the more compatible ABO blood group must be chosen and blood products be eliminated by filtration, when there has been blood reaction. When an allo-graft of hematopoitic tissues is considered an irradiation of blood products is necessary. Research is being carried out to develop substitute products for transfusion (haemoglobine solutions) or molecules acting on the syntheses of haemoglobine (butyrate arginine). The efficacy of erythropoitine, (EPO) is well recognised for stimulation of haemoglobine syntheses in renal failure and oncology.

Topics: Anaphylaxis; Chronic Disease; Erythropoietin; Hemolysis; Humans; Iron Overload; Shock, Septic; Transfusion Reaction

Anemia associated with end stage renal disease can diminish quality of life substantially. Maintaining a stable hematocrit and stable hemoglobin levels affords many advantages. Improvement of anemia management is possible with the implementation of continuous quality improvement (CQI). Our review of the literature motivated us to switch from iron dextran injection, which can induce anaphylactic reactions and has other associated problems, to sodium ferric gluconate complex injection. This enables us to safely provide iron supplementation without the precautions that were in place for iron dextran. Our methods for creating and implementing CQI in the dialysis program at our university hospital are described.

Topics: Algorithms; Anaphylaxis; Anemia, Iron-Deficiency; Decision Trees; Erythropoietin; Ferric Compounds; Ferritins; Hemoglobins; Humans; Iron-Dextran Complex; Kidney Failure, Chronic; Outcome and Process Assessment, Health Care; Practice Guidelines as Topic; Renal Dialysis; Total Quality Management; Transferrin

Topics: Anaphylaxis; Anemia; Comorbidity; Drug Therapy, Combination; Erythropoietin; Humans; Iron-Dextran Complex; Kidney Failure, Chronic; Recombinant Proteins; Renal Dialysis

Intravenous iron supplementation is an integral part of the management of anemia in patients with chronic kidney disease. Traditionally, this has been administered as an infusion over 1 or more hours, which requires the use of intravenous fluids and administration tubing, along with extra demands on patient and nursing time.. We prospectively investigated the safety and practicality of administering iron sucrose, 200 mg, as a bolus injection over 2 minutes in patients with chronic kidney disease. A total of 2,297 injections were administered to 657 patients. Any adverse events were recorded, including acute anaphylactoid reactions to the iron injection, along with the presence or absence of metallic taste and phlebitis, and these were classified as "serious" and "nonserious.". The most common adverse event was a mild and transient metallic taste that occurred during 412 injections (17.9%); in no case was this of significant distress to the patient. Excluding this, 2,240 injections (97.5%) proceeded uneventfully, and no case of phlebitis was recorded. Adverse events other than metallic taste were recorded in association with 57 injections (2.5%). Seven of these were caused by an acute anaphylactoid reaction to the intravenous iron. All 7 acute reactions resolved completely within 30 minutes with no sequelae, and none required hospitalization. The remaining 50 adverse events consisted of pain during the injection (n = 31), pain after the injection with or without some bruising (n = 9), nausea/gastrointestinal symptoms (n = 3), lethargy (n = 4), and lightheadedness (n = 3).. Administration of 200 mg of iron sucrose as an intravenous bolus injection over 2 minutes is a practical dosing regimen in patients with chronic kidney disease, resulting in considerable savings in time and cost.

Topics: Adult; Aged; Anaphylaxis; Anemia, Hypochromic; Chronic Disease; Cohort Studies; Dysgeusia; Erythropoietin; Female; Ferric Compounds; Ferric Oxide, Saccharated; Glucaric Acid; Graft Rejection; Humans; Hypotension; Injections, Intravenous; Kidney Diseases; Kidney Transplantation; Male; Middle Aged; Peritoneal Dialysis; Peritoneal Dialysis, Continuous Ambulatory; Prospective Studies

Topics: Anaphylaxis; Drug Hypersensitivity; Erythropoietin; Hematinics; Humans; Hypersensitivity, Immediate; Injections, Intravenous; Male; Middle Aged; Polyethylene Glycols; Renal Dialysis; Time Factors; Treatment Outcome

Topics: Adult; Anaphylaxis; Epoetin Alfa; Erythropoietin; Excipients; Female; Gelatin; Humans; Recombinant Proteins

Topics: Adult; Anaphylaxis; Anemia; Erythropoietin; Humans; Male; Recombinant Proteins

Topics: Anaphylaxis; Anemia; Animals; Antibodies; Centrifugation, Density Gradient; Chromatography; Complement Fixation Tests; Dialysis; Electrophoresis; Erythropoietin; Freeze Drying; Guinea Pigs; Hemagglutination Inhibition Tests; Humans; Immune Sera; Immunoassay; Immunoelectrophoresis; Iron Isotopes; Mice; Neutralization Tests; Polycythemia; Precipitins; Rabbits; Sheep; Spectrophotometry