Rx Note

Introduction Anemia is defined for patient care as a reduction in one or more of the major red blood cell measurements obtained as part of the complete blood count. Hemoglobin concentration To convert to mmol/L, the hemoglobin in g/dL can be multiplied by 0.62. Hematocrit Also called packed cell volume. Is the percentage of blood cell volume occupied by red blood cells. Red blood cell count A low hemolobin concentration and/or low hematocrit are the parameters most widely used to diagnose anemia. WHO criteria for anemia in adults are Females - Hemoglobin <12 g/dL or hematocrit <36% Males - Hemoglobin <13 g/dL or hematocrit < 39% NOTE: Reticulocytes are immature red blood cells. Symptoms Most patients with mild or early-stage anemia are asymptomatic. If anemia becomes severe and/or prolonged, the lack of oxygen in the blood can lead to classic symptoms of fatigue, weakness, shortness of breath, exercise intolerance, headache, dizziness, anorexia and/or pallor . If sudden ...

Introduction Iron deficiency anaemia is the most common cause of anaemia worldwide , accounting for approximately 50% of all cases. It is diagnosed when iron deficiency is accompanied by anaemia. Diagnostic lab findings: Complete blood count: Low red blood cell count (RBC), haemologbin (Hb), haematocrit (Hct) and mean corpuscular volume (MCV). Serum ferritin: <30 ng/ml (the threshold is typically higher in patients with chronic inflammatory state). Iron panel: Decreased serum iron and increased TIBC (total iron binding capacity) resulting in a lower transferrin saturation. NOTE: Transferrin saturation (TSAT) is the ratio of serum iron to TIBC: (serum iron ÷ TIBC x 100). If not provided directly by a lab, it can be calculated manually. Normal values range from 25 to 45%. Dietary Iron Dietary iron exists in two primary forms: Heme iron - found in meat, poultry and seafood Non-heme iron - found in nuts, beans, vegetables and fortified grains, such as cereals. Heme iron is mo...

Introduction Human milk is the optimal source of nutrition and protection for newborn infants because of its proven health benefits for both infants and their mothers. Breastfeeding is associated with child health benefits including reduced risk for acute otitis media, gastrointestinal and other infections, and may be associated with reduced risk for atopic dermatitis and asthma . Maternal health benefits may include reduced risk of some chronic diseases and cancer. The World Health Organization recommends breastfeeding exclusively for the first 6 months of life and then continued with the addition of complementary foods for up to 2 years and beyond. Overview of Postpartum Care All infants should be placed skin-to-skin with the mother immediately after either vaginal or caesarean birth, unless medically contraindicated (e.g. if the mother or infant is medically unstable. During this period of skin-to-skin contact, a first attempt at breastfeedin g should be encouraged. Weighing, m...

Introduction Pregnancy, typically lasts 37-40 weeks, is a critical period of rapid foetal growth and development as well as maternal physiological change. Nutrient requirements are increased to provide for the optimal growth and development of the foetus and to support maternal health. An additional of 340 to 450 kcal/day for pregnant women in second or third trimester. Lifestyle Modifications When treating pregnant patients, lifestyle modifications should always be considered first. Avoid alcohol and other known or potentially harmful substances (e.g. smoking, illicit drug and mercury) Avoid fish containing high levels of mercury (shark, billfish, tuna, swordfish). Limit caffeine intake to less than 200-300 mg per day. Be mindful of other forms of caffeine in black tea, coke, energy drinks and gym supplements. Teratogenic drugs should be discontinued prior to pregnancy, if possible. Preconception Care with Folic Acid Folic acid is recommended in all women of childbearing age. It is ...

Introduction Restless legs syndrome (RLS), also known as Willis-Ekbom disease (WEB), is a common sleep-related movement disorder characterized by an often unpleasant or uncomfortable urge to move the legs that occurs during periods of inactivity , particularly in the evenings and is transiently relieved by movement. Often, patients cannot describe their symptoms, but may describe the sensation as creeping, crawling, itching, burning, searing, tugging, pulling, drawing, aching, hot and cold, electric current–like, restless or painful. In half of RLS cases, both arms and legs are affected. Only arm symptoms are rare, and sometimes just one side is affected. RLS can occur at age, but it tends to get more frequent as people age. Risk Factors Family history and genetics Low iron stores Uremia secondary to renal failure Neuropathy related to a variety of underlying causes, including diabetes, alcohol, amyloid, motor neuron disease, poliomyelitis, and radiculopathy Pregnancy, especially in th...

Introduction Anaemia is diagnosed in adults and children >15 years when the haemoglobin concentration is <13 g/dL in males and <12 g/dL in females. The anaemia in ESRD patients normally presents as normocytic anaemia (normal MCV and MCHC) due to erythropoietin deficiency. Some patients may also have iron-deficiency anaemia . Prevalence: 26% of patients with a GFR greater than 60 ml/minute/1.73 m 2 have anaemia, compared with 78% of patients with a GFR less than 15 ml/minute/1.73 m 2 . Management Treatment encompasses identifying and correcting the underlying causes of anaemia. Several factors are responsible for anaemia in CKD: Decreased erythropoietin production (most important) Decrease in RBC life span caused by uraemia and effects of "uremic inhibitors" on bone marrow. Increase folate demand and depleted body stores. Dialysis induced blood and iron loss. Vitamin B12 deficiency - malnourished. Systemic infection/inflammatory diseases. Severe hyperparathyroidi...

Introduction In iron deficiency anaemia management, there are a number of settings in which the use of intravenous iron may be preferable to oral iron. Poor adherence or gastrointestinal side effects of oral iron. Prefer to replete iron stores in 1 or 2 visits rather than over the course of several months. Ongoing blood loss that exceeds the capacity of oral iron to meet needs (heavy uterine bleeding, mucosal telangiectasias). Anatomic or physiologic condition that interferes with oral iron absorption. Coexisting inflammatory state that interferes with iron homeostasis. Parenteral iron may also reduce the use of blood transfusion , which in turn avoids transfusion-associated risks. NOTE: IV iron is contraindicated in the first trimester of pregnancy. Choice of IV Formulation A number of IV iron formulations are available, including ferric carboxymaltose, ferric gluconate, ferumoxytol, iron sucrose, ferric derisomaltose (previously termed iron isomaltoside), and low molecular weigh...