iron and haemolytic anaemia

Re: iron and haemolytic anaemia

Martin Atkinson — Wed, 20 Aug 2014 10:13:14 GMT

[quote user="Hannah Wynne Richards"]A specialist advising B12[/quote]Just don't mention the anabolic steroids!

Re: iron and haemolytic anaemia

Martin Atkinson — Wed, 20 Aug 2014 10:12:25 GMT

[quote user="Rory Bell"] Do you measure their blood pressure following commencement of EPO?[/quote]I measure the blood pressure on a routine basis (at least every 3 months when they have their compulsory kidney test), not I'll admit specifically after they've EPO, but that is something I may now give more consideration to.

Re: iron and haemolytic anaemia

Hannah Wynne Richards — Wed, 20 Aug 2014 09:12:39 GMT

Yipee!!!!!!!!!!!

A specialist advising B12

wYNNE

Re: iron and haemolytic anaemia

Sara Ramsey — Tue, 19 Aug 2014 23:07:41 GMT

Thanks Very Much For The Input.

Re: iron and haemolytic anaemia

Rory Bell — Tue, 19 Aug 2014 21:05:03 GMT

Agreed - if they are EPO dependent then iron supplementation is necessary. Do you measure their blood pressure following commencement of EPO? It can increase significantly. And yes, agreed re: B12 as well, it's a good idea.

cheers

rory

Re: iron and haemolytic anaemia

Martin Atkinson — Tue, 19 Aug 2014 17:07:59 GMT

[quote user="Rory Bell"]Martin, perhaps some of your cats with CRF might have iron deficiency anaemia? of course, if you are giving EPO then iron supplementation is a very good idea. Just curious and trying to work out why it helps your patients.[/quote]I am giving EPO to my old anaemic CRF cats so the iron injections seemed a good idea as you suggest. Also some Vit B12 does no harm.

Re: iron and haemolytic anaemia

Rory Bell — Tue, 19 Aug 2014 17:01:38 GMT

I think clinical iron deficiency would be very unlikely if your dog had a strongly regenerative anaemia. Iron supplementation is relatively contraindicated in the absence of iron deficiency anaemia because of the possibility of gastrointestinal irritation if using an oral preparation as well as the risk of iron toxicity. Doses of 20mg/kg elemental iron can be enough to cause clinical signs.

Martin, perhaps some of your cats with CRF might have iron deficiency anaemia? of course, if you are giving EPO then iron supplementation is a very good idea. Just curious and trying to work out why it helps your patients.

cheers

rory

Re: iron and haemolytic anaemia

Julien Bazelle — Tue, 19 Aug 2014 16:56:56 GMT

Given the fact there is no exogenous blood loss and the efficiency of the reticuloendothelial system to recycle iron, it is unlikely that a dog with haemolytic anaemia develops iron deficiency. This is more frequently seen with mild but sustained GI or urine blood loss.

I would not treat a patient with iron supplement if there is no evidence of iron deficiency (e.g. microcytosis, hypochromasia associated with low iron, low ferritin or high total iron binding capacity). The only exception for CKD cats with anaemia that are receiving darbepoetin as iron deficiency may develop due to the increase bone marrow production.

[quote user="Martin Atkinson"]It does say in BSAVA formulary not to give iron to cases of anaemia other than those due to iron deficiency not sure why though. I often give it to anaemic old cats with CRF which seems to do no harm.[/quote]

Hypersensitivity reaction (if injected) or GI signs (if PO) are always possible in patients treated with iron supplementation. Interactions with other drugs are also difficult to predict and I always favor reducing the number of drugs administered by patients, especially in patients with renal disease when urinary excretion of the metabolites can be reduced.

Re: iron and haemolytic anaemia

Martin Atkinson — Tue, 19 Aug 2014 15:43:51 GMT

The MCHC should give you the answer to that. It does say in BSAVA formulary not to give iron to cases of anaemia other than those due to iron deficiency not sure why though. I often give it to anaemic old cats with CRF which seems to do no harm.