Macrocytic anemia medical therapy: Difference between revisions

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==Overview==
==Overview==
There is no treatment for [disease name]; the mainstay of therapy is supportive care.
OR
Supportive therapy for [disease name] includes [therapy 1], [therapy 2], and [therapy 3].
OR
The majority of cases of [disease name] are self-limited and require only supportive care.
OR
[Disease name] is a medical emergency and requires prompt treatment.
OR
The mainstay of treatment for [disease name] is [therapy].
OR
 
The optimal therapy for [malignancy name] depends on the stage at diagnosis.
OR
[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 with [disease subclass 1], [disease subclass 2], and [disease subclass 3].  
*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>
*Pharmacologic medical therapies for [disease name] include (either) [therapy 1], [therapy 2], and/or [therapy 3].
*Empiric therapy for [disease name] depends on [disease factor 1] and [disease factor 2].
*Patients with [disease subclass 1] are treated with [therapy 1], whereas patients with [disease subclass 2] are treated with [therapy 2].
===Disease Name===


* '''1 Stage 1 - Name of stage'''
* '''Vitamin B12 deficiency'''
** 1.1 '''Specific Organ system involved 1'''
** '''Mild'''  
*** 1.1.1 '''Adult'''
**** Preferred regimen (1): [[drug name]] 100 mg PO q12h for 10-21 days '''(Contraindications/specific instructions)''' 
**** Preferred regimen (2): [[drug name]] 500 mg PO q8h for 14-21 days
**** Preferred regimen (3): [[drug name]] 500 mg q12h for 14-21 days
**** Alternative regimen (1): [[drug name]] 500 mg PO q6h for 7–10 days 
**** Alternative regimen (2): [[drug name]] 500 mg PO q12h for 14–21 days
**** Alternative regimen (3): [[drug name]] 500 mg PO q6h for 14–21 days
*** 1.1.2 '''Pediatric'''
**** 1.1.2.1 (Specific population e.g. '''children < 8 years of age''')
***** Preferred regimen (1): [[drug name]] 50 mg/kg PO per day q8h (maximum, 500 mg per dose) 
***** Preferred regimen (2): [[drug name]] 30 mg/kg PO per day in 2 divided doses (maximum, 500 mg per dose)
***** Alternative regimen (1): [[drug name]]10 mg/kg PO q6h (maximum, 500 mg per day)
***** Alternative regimen (2): [[drug name]] 7.5 mg/kg PO q12h (maximum, 500 mg per dose)
***** Alternative regimen (3): [[drug name]] 12.5 mg/kg PO q6h (maximum, 500 mg per dose)
****1.1.2.2 (Specific population e.g. '<nowiki/>'''''children < 8 years of age'''''')
***** Preferred regimen (1): [[drug name]] 4 mg/kg/day PO q12h（maximum, 100 mg per dose）
***** Alternative regimen (1): [[drug name]] 10 mg/kg PO q6h (maximum, 500 mg per day)
***** Alternative regimen (2): [[drug name]] 7.5 mg/kg PO q12h (maximum, 500 mg per dose) 
***** Alternative regimen (3): [[drug name]] 12.5 mg/kg PO q6h (maximum, 500 mg per dose)
** 1.2 '''Specific Organ system involved 2'''
*** 1.2.1 '''Adult'''
**** Preferred regimen (1): [[drug name]] 500 mg PO q8h
*** 1.2.2  '''Pediatric'''
**** Preferred regimen (1): [[drug name]] 50 mg/kg/day PO q8h (maximum, 500 mg per dose)


* 2 '''Stage 2 - Name of stage'''
** 2.1 '''Specific Organ system involved 1 '''
**: '''Note (1):'''
**: '''Note (2)''':
**: '''Note (3):'''
*** 2.1.1 '''Adult'''
**** Parenteral regimen
**** Parenteral regimen
***** Preferred regimen (1): [[drug name]] 2 g IV q24h for 14 (14–21) days
***** 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): [[drug name]] 2 g IV q8h for 14 (14–21) days
***** Alternative regimen (2): [[drug name]] 18–24 MU/day IV q4h for 14 (14–21) days
**** Oral regimen
**** Oral regimen
***** Preferred regimen (1): [[drug name]] 500 mg PO q8h for 14 (14–21) days
***** Preferred regimen (1): [[Cyanocobalamin Injection|Cyanocobalamin]] 500-1000 μg PO q24h<ref name="pmid23301732" />
***** Preferred regimen (2): [[drug name]] 100 mg PO q12h for 14 (14–21) days
*** '''Severe'''
***** Preferred regimen (3): [[drug name]] 500 mg PO q12h for 14 (14–21) days
***** Alternative regimen (1): [[drug name]] 500 mg PO q6h for 7–10 days 
***** Alternative regimen (2): [[drug name]] 500 mg PO q12h for 14–21 days
***** Alternative regimen (3):[[drug name]] 500 mg PO q6h for 14–21 days
*** 2.1.2 '''Pediatric'''
**** Parenteral regimen
**** Parenteral regimen
***** Preferred regimen (1): [[drug name]] 50–75 mg/kg IV q24h for 14 (14–21) days (maximum, 2 g)
***** Preferred regimen (1):[[Cyanocobalamin Injection|Cyanocobalamin]] 1000 μg IM q24h for 7 days, then q weekly for 4-8 weeks <ref name="pmid23301732" /><nowiki/>
***** 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) '<nowiki/>'''''(Contraindications/specific instructions)''''''
**** 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]]1000-2000 μg PO q24h<ref name="pmid23301732" />
***** Preferred regimen (2): [[drug name]] '''(for children aged ≥ 8 years)''' 4 mg/kg/day PO q12h for 14 (14–21) days (maximum, 100 mg per dose)
**
***** Preferred regimen (3): [[drug name]] 30 mg/kg/day PO q12h for 14 (14–21) days  (maximum, 500 mg per dose)
*** '''Pernicious anemia'''
***** Alternative regimen (1):  [[drug name]] 10 mg/kg PO q6h 7–10 days  (maximum, 500 mg per day)
***** Alternative regimen (2): [[drug name]] 7.5 mg/kg PO q12h for 14–21 days  (maximum, 500 mg per dose)
***** Alternative regimen (3): [[drug name]] 12.5 mg/kg PO q6h for 14–21 days  (maximum,500 mg per dose)
** 2.2  '<nowiki/>'''''Other Organ system involved 2''''''
**: '''Note (1):'''
**: '''Note (2)''':
**: '''Note (3):'''
*** 2.2.1 '''Adult'''
**** Parenteral regimen
**** Parenteral regimen
***** Preferred regimen (1): [[drug name]] 2 g IV q24h for 14 (14–21) days
***** 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): [[drug name]] 2 g IV q8h for 14 (14–21) days
***** 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>
***** Alternative regimen (2): [[drug name]] 18–24 MU/day IV q4h for 14 (14–21) days
**** Oral regimen
**** Oral regimen
***** Preferred regimen (1): [[drug name]] 500 mg PO q8h for 14 (14–21) days
***** Preferred regimen (1): [[Cyanocobalamin Injection|Cyanocobalamin]]1000-2000 μg PO q24h<ref name="pmid23301732" />
***** Preferred regimen (2): [[drug name]] 100 mg PO q12h for 14 (14–21) days
*
***** Preferred regimen (3): [[drug name]] 500 mg PO q12h for 14 (14–21) days
*** '''Gastric bypass'''
***** Alternative regimen (1): [[drug name]] 500 mg PO q6h for 7–10 days 
***** Alternative regimen (2): [[drug name]] 500 mg PO q12h for 14–21 days
***** Alternative regimen (3):[[drug name]] 500 mg PO q6h for 14–21 days
*** 2.2.2 '''Pediatric'''
**** Parenteral regimen
**** Parenteral regimen
***** Preferred regimen (1): [[drug name]] 50–75 mg/kg IV q24h for 14 (14–21) days (maximum, 2 g)
***** 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): [[drug name]] 150–200 mg/kg/day IV q6–8h for 14 (14–21) days (maximum, 6 g per day)
***** Alternative regimen (1): [[Cyanocobalamin Injection|Cyanocobalamin]] 1000 μg IM  q monthly<ref name="pmid23301732" />
***** 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
**** 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
      • Severe
        • Parenteral regimen
          • Preferred regimen (1):Cyanocobalamin 1000 μg IM q24h for 7 days, then q weekly for 4-8 weeks [1]
        • Oral 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
    • 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. ↑ 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.
  2. ↑ Oh R, Brown DL (March 2003). "Vitamin B12 deficiency". Am Fam Physician. 67 (5): 979–86. PMID 12643357.
  3. ↑ 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.

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