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Is there a general guideline for dosage amounts and frequency of EPO? and IV iron?

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A friend was discharged from hospital in need of a triple bypass with a blood count of 7.

(Blood thinners were administered and bleeding ulcers caused the drop in hemoglobin.)

At stent was done and she was released to get blood count up on outpatient basis.

Are there typical amounts prescribed and with a certain frequency with someone in this somewhat urgent situation?

Is there a minimum standard?

And should we expect IV iron to be administered along with the EPO?

Otherwise, we will travel to our nearest bloodless medical center, which is what I had to do with my dad when he was in a similar situation.

Thanks in advance for any specifics or guidelines you can provide here
asked May 13, 2012 in Conditions and Treatments by julesandmel (160 points)
edited Jun 4, 2012 by LarryEitel

3 Answers

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Yes there are guidelines - which according to Dr. Shander are more regularitory body driven than by science.

Amount and frequency depends upon various factors including if you get EPO or another ESA such as Darbepoetin.

In the US they - for cancers at least - can't start until count drops below 10 gm/dl and stops when count reaches 10 gm/dl.

In Europe the count is higher however should be stopped in kidney patients about 12-13 gm/dl

One should never try to get hemoglobin count to normal range with drugs.

In Europe and possibly the U.S. new guidelines are being drawn up with higher levels - esp in cancer patients - since original studies were flawed.

Source: Anemia & use of ESA ( erythopoisis stimulating agents ) conferences 2 ( Nov 2010 ) and 3 ( Nov 2011 )
answered May 16, 2012 by pnutts (1,820 points)

"One should never try to get hemoglobin count to normal range with drugs."


You should update the Erythropoietin/Procrit guidelines every 6 months and I am requesting for guidelines throughout California, as I have been told that they are higher because the lab levels for normal hemoglobin are lower (11 rather than 12). They told me administration of Procrit was, therefore, given at a lower hemoglobin than10, and, could be determined by the hematologist or other doctor (at that time nephrologist), rather than going by the protocol for Procrit. Is that true? I've never heard any of that before. Someone please comment as I will be able to submit any input. I don't want to have to beg for Procrit anymore.
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To make good oxygen-carrying red blood cells, you need iron, B12, Folic acid and Vitamin C.  The patient's primary care physician can send her to an infusion center with a standard order for IV iron, B12 shot and an erythropoietin stimulating agent (ESA).  For your part, make some good choices in her diet.  A cup of oatmeal has 10 milligrams of iron.  Search on the internet for an iron rich diet.  If you email me privately, I can send you an algorithym to bring to the doctor.
answered May 17, 2012 by jlvarisco (2,070 points)
That's helpful, thank you.

I don't see how to email you privately for the algorithym . . . could you email it to me?
Here is a link to Private Message her. You must be registered and logged in.
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EPO dosing recommendation for surgery,  CKD and Cancer are part of the extensive package insert.  As for iron, it depends on the indication.
answered May 26, 2012 by AShanderMD (180 points)
My son was given epo therapy at a rate of 30.000 international units per week until his Hgb reached 18/19 and then underwent huge cardiac surgery with great sucess.

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