losartan-potassium and Fever

Topics: Acidosis; Apoptosis; Brain Ischemia; Erythropoietin; Fever; Fibrinolytic Agents; Forecasting; Humans; Hyperglycemia; Myocardial Ischemia; Tissue Plasminogen Activator

For previously untreated patients receiving most chemotherapy regimens, primary prophylactic administration of granulocyte colony-stimulating factor (G-CSF) cannot be recommended. Secondary prophylactic G-CSF administration can lessen incidence of febrile neutropenia (FN) in subsequent cycles of chemotherapy in patients with a prior episode of FN. Physicians should consider chemotherapy dose reduction after neutropenic fever or severe or prolonged neutropenia after the previous cycle of treatment. Intervention with G-CSF in afebrile neutropenic patients is not recommended. For the majority of patients with FN, the available data do not clearly support the routine initiation of G-CSF as an adjunct to antibiotic therapy. However, certain FN patients may have prognostic factors that are predictive of clinical deterioration, such as pneumonia, hypotension, multiorgan dysfunction (sepsis syndrome), or fungal infection. The therapeutic use of G-CSF together with antibiotics may be reasonable in such high-risk patients. Empirical antifungal therapy is effective, especially for patients with neutropenia who were treated for seven days with empirical antibiotic therapy but remained febrile, or became afebrile but then had recurrent fever. The patient's overall clinical status and laboratory parameters are both considered when deciding to transfuse a patient. Epoetin may be available for use in the future as a treatment option for patients with chemotherapy-associated anemia with a hemoglobin level less than 10 g/dl. Giving prophylactic platelets at a threshold of 10,000/microliter compared with 20,000/microliter can decrease the total utilization of platelets with only a small adverse effect on bleeding, and no statistically significant effect on morbidity.

Topics: Anemia; Anti-Bacterial Agents; Antineoplastic Combined Chemotherapy Protocols; Blood Transfusion; Erythropoietin; Fever; Granulocyte Colony-Stimulating Factor; Guidelines as Topic; Humans; Neoplasms; Neutropenia; Platelet Transfusion; Recombinant Proteins; Risk

Topics: Anemia; Animals; Antineoplastic Agents; Bone Marrow Transplantation; Erythropoietin; Fever; Granulocyte Colony-Stimulating Factor; Granulocyte-Macrophage Colony-Stimulating Factor; Hematopoietic Cell Growth Factors; Humans; Neoplasms; Neutropenia; Recombinant Proteins; Stomatitis

Topics: Anemia; Bone Marrow Transplantation; Colony-Stimulating Factors; Erythropoietin; Fever; Granulocyte Colony-Stimulating Factor; Granulocyte-Macrophage Colony-Stimulating Factor; Humans; Neoplasms; Neutropenia; Radiotherapy; Thrombocytopenia

Topics: Anemia, Hemolytic; Anemia, Hemolytic, Autoimmune; Animals; Body Temperature Regulation; Cell Membrane; Cell Survival; Chromium Radioisotopes; Chronic Disease; Endotoxins; Erythrocytes; Erythropoiesis; Erythropoietin; Fever; Hematocrit; Hemolysis; Hot Temperature; Iron; Lipid Metabolism; Mononuclear Phagocyte System; Phagocytosis; Rabbits; Spleen

This phase 3, randomized, double-blind, placebo-controlled study was designed to evaluate the efficacy and safety of darbepoetin alfa in anaemic patients with lymphoproliferative malignancies. Patients (n = 344) with lymphoma or myeloma received darbepoetin alfa 2.25 microg/kg or placebo s.c., once weekly for 12 weeks. The percentage of patients achieving a haemoglobin response was significantly higher in the darbepoetin alfa group (60%) than in the placebo group (18%) (P < 0.001), regardless of baseline endogenous erythropoietin level. However, increased responsiveness was observed in patients with lower baseline erythropoietin levels. Darbepoetin alfa also resulted in higher mean changes in haemoglobin than placebo from baseline to the last value during the treatment phase (1.80 g/dl vs 0.19 g/dl) and after 12 weeks of treatment (2.66 g/dl vs 0.69 g/dl). A significantly lower percentage of patients in the darbepoetin alfa group received red blood cell transfusions than in the placebo group (P < 0.001). The efficacy of darbepoetin alfa was consistent for patients with lymphoma or myeloma. Improvements in quality of life were also observed with darbepoetin alfa. The overall safety profile of darbepoetin alfa was consistent with that expected for this patient population. Darbepoetin alfa significantly increased haemoglobin and reduced red blood cell transfusions in patients with lymphoproliferative malignancies receiving chemotherapy.

Topics: Aged; Analysis of Variance; Anemia; Blood Transfusion; Darbepoetin alfa; Diarrhea; Double-Blind Method; Erythropoietin; Fatigue; Female; Fever; Follow-Up Studies; Humans; Linear Models; Lymphoma; Lymphoproliferative Disorders; Male; Middle Aged; Multiple Myeloma; Nausea; Quality of Life

A prospective, randomized trial comparing Epoetin alfa (Procrit) with placebo saline injection to determine effectiveness in increasing erythropoietic recovery in complex spine deformity surgery.. To determine if Epoetin alfa can allow preoperative autologous donation completion more effectively and reduce perioperative homologous blood transfusion.. The use of Epoetin alfa has been studied, primarily in the arthroplasty literature, for its effectiveness in decreasing transfusion requirements and increasing hemoglobin levels. It has not been studied in patients undergoing complex spine deformity surgery.. A total of 48 patients were prospectively randomized into an Epoetin alfa group and a control group. All patients attempted to donate 4 units of preoperative autologous donation at weekly intervals; 40,000 units of Epoetin alfa were injected subcutaneously at the time of preoperative autologous donation in the Epoetin alfa group. Hematocrit levels were recorded weekly during the donation process and daily in the preoperative period.. Preoperative autologous donation was completed more effectively in the patients receiving Epoetin alfa. Epoetin alfa resulted in statistically higher hematocrit levels during preoperative autologous donation and perioperatively (P < 0.005). Homologous transfusion was decreased by 2.4 units and hospital stay was 1.8 days shorter in patients receiving Epoetin alfa.. Patients who received Epoetin alfa were able to complete preoperative autologous donation more effectively, increase erythropoietic recovery, decrease homologous transfusion requirements, and had shorter hospital stays.

Topics: Adult; Aged; Blood Donors; Blood Loss, Surgical; Blood Transfusion, Autologous; Constipation; Contraindications; Epoetin Alfa; Erythropoietin; Female; Fever; Hematocrit; Humans; Injections, Subcutaneous; Length of Stay; Male; Middle Aged; Postoperative Complications; Postoperative Nausea and Vomiting; Preoperative Care; Prospective Studies; Recombinant Proteins; Sepsis; Spinal Curvatures; Spinal Fusion; Treatment Outcome

Ectopic pregnancy (EP) is an emergency condition in the gynecologic field. Methotrexate (MTX) is a drug of choice for the medical treatment of EP. Severe adverse events are rare among patients treated with MTX for this condition.. We describe a woman with severe multi-organ involvement experiencing about six days of instability after treatment with just a single-dose MTX for EP. This life-threatening condition is not common with a single dose of MTX. A 30-year-old healthy woman was treated medically with MTX for an EP. Three days later the patient was admitted to the emergency department of our hospital with generalized pustular rashes, alopecia, hyperpigmentation, nausea and vomiting, oral ulcers, and raised Creatinine level. Four days later due to pancytopenia, fever, and loss of consciousness, she was transferred to the intensive care unit and was intubated.. After 38 days of hospitalization, treatment was successful with leucovorin and supportive care and the patient's symptoms and clinical manifestations were regressed.

Topics: Abortifacient Agents, Nonsteroidal; Adult; Alopecia; Anti-Bacterial Agents; Drug Hypersensitivity; Erythropoietin; Female; Fever; Granulocyte Colony-Stimulating Factor; Humans; Hyperpigmentation; Meropenem; Methotrexate; Pancytopenia; Platelet Transfusion; Pregnancy; Pregnancy, Ectopic; Pseudomonas aeruginosa; Pseudomonas Infections; Unconsciousness

An 80-year-old man with multiple comorbidities presented to the emergency department with tachypnea, tachycardia, fever, and critically low O

Topics: Aged, 80 and over; Anemia; Antiviral Agents; Betacoronavirus; Biomarkers; Clinical Laboratory Techniques; Convalescence; Coronavirus Infections; COVID-19; COVID-19 Testing; Critical Illness; Erythropoietin; Fever; Humans; Iran; Male; Pandemics; Pneumonia, Viral; Reverse Transcriptase Polymerase Chain Reaction; RNA, Viral; SARS-CoV-2; Tachycardia; Tachypnea; Tomography, X-Ray Computed; Treatment Outcome

Myelofibrosis (MF) is characterized by shortened survival and a greatly compromised quality of life. Weight loss and cachexia seem to be the most important factors influencing survival in patients with MF. The aim of this study was to assess the efficacy of an integrated supportive therapy in improving cachexia and MF-related symptoms.. We reported on a case of a patient with MF who presented with weight loss and cachexia associated with severe anemia, fatigue, fever, and bone pain. The circulating levels of inflammatory, oxidative stress parameters, hepcidin, and erythropoietin were evaluated and were above normal ranges. The patient was treated with a multitargeted approach specifically developed for cachexia including oral l-carnitine, celecoxib, curcumin, lactoferrin, and subcutaneous recombinant human erythropoietin (EPO)-α.. Surprisingly, after 1 y, cachexia features improved, all MF symptoms were in remission, and inflammatory and oxidative stress parameters, hepcidin, and EPO were reduced.. Because our protocol was targeted at inflammation and the metabolic state, its effectiveness may emphasize the role of inflammation in the pathogenesis of MF symptoms and demonstrates a need for the study of new integrated therapeutic strategies.

Topics: Anemia; C-Reactive Protein; Cachexia; Carnitine; Celecoxib; Curcumin; Erythropoietin; Fatigue; Ferritins; Fever; Hepcidins; Humans; Interleukin-6; Iron; Lactoferrin; Male; Middle Aged; Oxidative Stress; Patient Compliance; Primary Myelofibrosis; Quality of Life; Reactive Oxygen Species; Recombinant Proteins; Treatment Outcome; Tumor Necrosis Factor-alpha; Weight Loss

Chemotherapy induced neutropenia (CIN), febrile neutropenia (FN), chemotherapy induced anemia (CIA) frequently occur following myelosuppressive chemotherapy and are associated with morbidity, mortality, costs, and relative dose intensity (RDI), hence influencing overall survival (OS). Given prophylactically, granulocyte colony-stimulating factors (G-CSFs) can stimulate neutrophil production and depletion, they may thus reduce FN incidence when following chemotherapy. Erythropoietins are widely used to treat chemotherapy induced anemia. Several guidelines have been published to help onco-hematologists design their supportive therapy. The aim of our study was to assess the guidelines concerning everyday routine in supportive care. The final conclusion is that the Hungarian therapy support guidelines are up to date, are highly compliant with international standards [ASCO (1), EORTC (2), ESMO (3, 4), NCCN (5-7)], and that the clinicians have a deep understanding and comprehensive usage in their everyday practice.. A kemoterápia indukálta neutropénia (CIN - chemotherapy induced neutropenia), a lázas neutropénia (FN - febrile neutropenia) és a kemoterápia indukálta anémia (CIA - chemotherapy induced anemia) a mieloszuppresszív kemoterápia gyakran elõforduló mellékhatásai. Ezeknek a toxikus mellékhatásoknak súlyos következménye lehet a morbiditás, mortalitás, a költségek, a relatív dózisintenzitás (RDI - relative dose intensity) és így akár a túlélés szempontjából is. A profilaktikusan alkalmazott granulocita-kolóniastimuláló faktor sikeresen megelõzheti a lázas neutropénia kialakulását a neutrofiltermelõdés és -depléció fokozásával. A kemoterápia indukálta anémia kezelésére eritropoetint használunk. Számos terápiás ajánlás mellett magyar minisztériumi szakmai irányelv is segít az onkohematológiai kezelések szupportív terápiájának megtervezésében. Vizsgálatunk célja az volt, hogy összevessük a hazai gyakorlatot az ajánlásokkal. Megállapítottuk, hogy a magyar szakmai irányelv modern, összhangban van a nemzetközi ajánlásokkal, a klinikusok jól ismerik és megfelelõen alkalmazzák.

Topics: Administration, Oral; Anemia; Clinical Protocols; Drug Prescriptions; Erythropoietin; Fever; Granulocyte Colony-Stimulating Factor; Hematinics; Hematology; Humans; Hungary; International Cooperation; Iron Compounds; Medical Oncology; Neutropenia; Practice Guidelines as Topic; Surveys and Questionnaires

To investigate the efficaciousness of recombinant human granulocyte colony-stimulating factor (G-CSF) combined with recombinant human erythropoietin (EPO) in the treatment of patients with myelodysplastic syndrome (MDS), the hematological changes in the blood and bone marrow along with clinical features after treatment with G-CSF and EPO in 15 patients were observed. Patients were subcutaneously injected with G-CSF 300 microg/d for 10 days, then injected with EPO 100 U/(kg x d) for 10 days. The results showed that the obvious improvements in granulocytes of blood were found in 10 patients with MDS, improvements in erythrocytes of blood were observed in 7 patients with MDS. No serious side effects occured is all treated patients. In conclusion, treatment of G-CSF in combination with EPO is effective for patients with MDS.

Topics: Adult; Aged; Drug Therapy, Combination; Erythrocyte Count; Erythropoietin; Female; Fever; Granulocyte Colony-Stimulating Factor; Headache; Humans; Injections, Subcutaneous; Leukocyte Count; Male; Middle Aged; Myelodysplastic Syndromes; Recombinant Proteins; Treatment Outcome

Topics: Drug Hypersensitivity; Eosinophilia; Epoetin Alfa; Erythema Multiforme; Erythropoietin; Exanthema; Fever; Hematinics; Humans; Male; Middle Aged; Recombinant Proteins; Syndrome

In a one month period, 10 Serratia liquefaciens bloodstream infections and 6 pyrogenic reactions occurred in outpatients at a hemodialysis center.. We performed a cohort study of all hemodialysis sessions on days that staff members reported S. liquefaciens bloodstream infections or pyrogenic reactions. We reviewed procedures and cultured samples of water, medications, soaps, and hand lotions and swabs from the hands of personnel.. We analyzed 208 sessions involving 48 patients. In 12 sessions, patients had S. liquefaciens bloodstream infections, and in 8, patients had pyrogenic reactions without bloodstream infection. Sessions with infections or reactions were associated with higher median doses of epoetin alfa than the 188 other sessions (6500 vs. 4000 U, P=0.03) and were more common during afternoon or evening shifts than morning shifts (P=0.03). Sessions with infections or reactions were associated with doses of epoetin alfa of more than 4000 U (multivariate odds ratio, 4.0; 95 percent confidence interval, 1.3 to 12.3). A review of procedures revealed that preservative-free, single-use vials of epoetin alfa were punctured multiple times, and residual epoetin alfa from multiple vials was pooled and administered to patients. S. liquefaciens was isolated from pooled epoetin alfa, empty vials of epoetin alfa that had been pooled, antibacterial soap, and hand lotion. All the isolates were identical by pulsed-field gel electrophoresis. After the practice of pooling epoetin alfa was discontinued and the contaminated soap and lotion were replaced, no further S. liquefaciens bloodstream infections or pyrogenic reactions occurred at this hemodialysis facility.. Puncturing single-use vials multiple times and pooling preservative-free epoetin alfa caused this outbreak of bloodstream infections in a hemodialysis unit. To prevent similar outbreaks, medical personnel should follow the manufacturer's guidelines for the use of preservative-free medications.

Topics: Adult; Aged; Aged, 80 and over; Ambulatory Care Facilities; Bacteremia; Cohort Studies; Colorado; Cosmetics; Cross Infection; Data Collection; Disease Outbreaks; Drug Contamination; Epoetin Alfa; Erythropoietin; Female; Fever; Humans; Male; Middle Aged; Odds Ratio; Recombinant Proteins; Renal Dialysis; Serratia; Serratia Infections; Soaps; United States

To evaluate the pattern of erythropoietin (EPO) and some proinflammatory cytokines in the anemia of chronic disorders (ACD) secondary to infection.. Sequential determination in serum of interleukin-1 beta (IL-1 beta), necrosis tumoral factor alpha (TNF-alpha), gamma interferon (IFN-gamma), interleukin-6 (IL-6), and erythropoietin (EPO) in 25 patients with chronic bacterial infectious diseases and ACD criteria. We evaluated the relationship of these mediators with the anemia and the iron metabolism.. Serum EPO levels significatively decreased compared with initial values, and the last control was in normal rank (18.04 +/- 19.10 vs. 8.56 +/- 4.72 UI/mL; p < 0.001; normal rank: 4-15 mUI/mL). In the first control, there was a negative and non significative correlation between the EPO levels and the hemoglobin concentration (r = -0.115, NS), reaching significance in the last control (r = -0.446; p < 0.05). There was negative correlation between the hematocrit and TNF-alpha levels (r = 0.467; p < 0.05) and between the haemoglobin values and the log of serum TNF-alpha (r = 0.424; p < 0.001). An inverse correlation between the IL-6 levels and both, the hemoglobin concentration and the serum iron was found, and there was a direct correlation between this cytokine values and the EPO levels.. Blunted response of erythropoietin and the action of TNF may contribute to the pathogenesis of ACD secondary to infection. Positive correlation between IL-6 and EPO suggest a proerythropoietic action of IL-6 in response to the anemia.

Topics: Adult; Aged; Anemia; Bacterial Infections; Chronic Disease; Cytokines; Erythropoietin; Female; Fever; Hematocrit; Hemoglobinometry; Humans; Interferon-gamma; Interleukin-1; Interleukin-6; Male; Middle Aged; Tumor Necrosis Factor-alpha

Topics: Abdominal Pain; Adult; Analgesics, Non-Narcotic; Anemia, Iron-Deficiency; Appendicitis; Epoetin Alfa; Erythropoietin; Fever; Gastrointestinal Hemorrhage; Glomerulonephritis; Hematinics; Humans; Hypertension; Ibuprofen; Kidney Failure, Chronic; Male; Nursing Diagnosis; Peritoneal Dialysis, Continuous Ambulatory; Peritonitis; Recombinant Proteins; Renal Dialysis

A 35-year-old man from Central America with a history of AIDS and numerous opportunistic infections presented with progressive neutropenia and thrombocytopenia despite having been stable for a period of 6 months. Cessation of antiviral medications did not stop his neutropenia, nor did use of folinic acid, G-CSF, or erythropoietin. The failure of these measures required repeated blood transfusions. Although the physical examination was relatively unremarkable, hematology and blood chemistries indicated that the patient needed urgent hospitalization due to fever and neutropenia. Neutropenia within HIV infection can be confusing, since it may be a result of the infection itself, an adverse effect of drug therapy, or from an opportunistic infection or malignancy. If the cause is not evident, it is wise to seek the etiology first rather than immediately use bone marrow stimulants, such as G-CSF. In this case, an infectious disease specialist made a diagnosis of disseminated histoplasmosis, after which the patient was treated with amphotericin B and released on itraconazole maintenance therapy.

Topics: Acquired Immunodeficiency Syndrome; Adult; Amphotericin B; Antifungal Agents; Erythropoietin; Fever; Granulocyte Colony-Stimulating Factor; Histoplasmosis; Humans; Male; Mucous Membrane; Neutropenia

We report a patient with severe anaemia and cyclic oscillations of reticulocyte and leucocyte counts, as well as serum iron (Fe), unsaturated iron-binding capacity (UIBC), ferritin, C-reactive protein (CRP) levels and temperature, at regular intervals of 7 or 8 d. After treatment with prednisolone, anaemia was corrected and the cyclic oscillations of these parameters ceased; whereas treatment with indomethacin, recombinant granulocyte-colony stimulating factor (G-CSF) and erythropoietin (Epo) were unsuccessful.

Topics: Adult; Anemia; C-Reactive Protein; Erythropoietin; Female; Fever; Granulocyte Colony-Stimulating Factor; Hematopoiesis; Humans; Indomethacin; Leukocyte Count; Periodicity; Phagocytosis; Prednisolone; Reticulocytes

12 patients with myelodysplastic syndromes were treated with recombinant human erythropoietin (r-epo). 5 patients had stable anemia, 78-92 g/l, and 7 were transfusion-dependent. In 11 patients, r-epo was given intravenously three times a week, with dose escalation after 4 and 8 wk if hemoglobin did not increase more than 15 g/l. The doses were 600, 1500 and 3000 U/kg bodyweight/wk. The 12th patient was treated subcutaneously with a dose of 560 U/kg/wk. 3 patients showed a significant response with an increase in hemoglobin of greater than or equal to 15 g/l. 2 of these had stable anemia before treatment and increased in hemoglobin from 87 to 116 g/l and from 80 to 99 g/l, respectively. The 3rd patient was transfusion-dependent and rose to a stable hemoglobin level between 76 and 80 g/l without transfusions. 2 patients showed a reduction of their transfusion need. Mean initial serum erythropoietin in the responding group was 366 U/l compared to 1049 among the non-responders (p = 0.367). Response was observed in 5/7 patients without bone marrow sideroblasts and in 0/5 patients with sideroblasts (p = 0.027). Erythropoietin seems to be an effective and well-tolerated treatment for a certain proportion of patients with MDS. A larger patient material might provide a model for predicting responses.

Topics: Adult; Aged; Aged, 80 and over; Drug Administration Schedule; Erythropoietin; Female; Fever; Humans; Male; Middle Aged; Myelodysplastic Syndromes; Recombinant Proteins; Thrombocytopenia

Topics: Adenocarcinoma; Alkaline Phosphatase; Erythropoietin; Female; Fever; Haptoglobins; Hepatomegaly; Humans; Infant; Kidney Neoplasms; Leukemoid Reaction; Renin; Splenomegaly; Urography