Macrocytic anemia medical therapy
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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
- Preferred regimen (1): Cyanocobalamin 500-1000 μg PO q24h[1]
- Parenteral 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
- Preferred regimen (1): Cyanocobalamin1000-2000 μg PO q24h[1]
- Parenteral 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
- Preferred regimen (1): Cyanocobalamin1000-2000 μg PO q24h[1]
- Parenteral regimen
- Pernicious anemia
-
- Gastric bypass
- Parenteral regimen
- Preferred regimen (1):Cyanocobalamin 1000 μg IM or SQ q monthly[3]
- Alternative regimen (1): Cyanocobalamin 1000 μg IM q monthly[1]
- Oral regimen
- Preferred regimen (1): Cyanocobalamin 350-500μg PO q24h[3]
- Alternative regimen (1): Cyanocobalamin 1000-2000 μg PO q24h[1] Pediatric
- Parenteral regimen
- Gastric bypass
- 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
- ↑ 1.0 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.
- ↑ Oh R, Brown DL (March 2003). "Vitamin B12 deficiency". Am Fam Physician. 67 (5): 979–86. PMID 12643357.
- ↑ 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.