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General and Risk Management, Patient Safety (including: medication errors, quality control)
Haemoglobin levels in patients with anaemia associated with chronic renal failure in predialysis, treated with subcutaneous erythropoietin
  1. P. Carmona Oyaga,
  2. I. Aranguren Ruiz,
  3. P. Martín Andrés,
  4. L. Gómez De Segura Iriarte,
  5. L. Leunda Eizmendi,
  6. A. Asensio Bermejo,
  7. P. Pascual González,
  8. J. Barral Juez,
  9. M.J. Gayan Lera,
  10. E. Esnaola Barrena
  1. 1Donostia University Hospital, Hospital Pharmacy, San Sebastián, Spain
  2. 2Aita Menni Hospital, Hospital Pharmacy, Mondragon, Spain
  3. 3Central University Hospital of Asturias, Hospital Pharmacy, Oviedo, Spain

Abstract

Background It is necessary to monitor the effect of erythropoietin (EPO) on haemoglobin (Hb) levels to check the efficacy and safety of the medicine. The desirable therapeutic range of Hb according to the product information is from 10 to 12 g/dl and higher or lower levels can damage health. The tolerance, clinical need and urgency required in the resolution of the anaemia varies among patients, however, Hb ≥13 g/dl is associated with cardiovascular events such as thromboembolism, requiring urgent care.

Purpose To determine the proportion of patients with anaemia linked to chronic renal failure in predialysis treated with EPO, with a value of Hb within or outside (lower or higher than) the therapeutic range.

Materials and methods A retrospective study was performed of 155 nephrology patients who collect erythropoietin at the outpatient unit of the hospital pharmacy; duration 1 month. All of them had anaemia associated with chronic renal failure in predialysis and were treated with subcutaneous erythropoietin for at least 4 weeks. The outpatient dispensing program compiles items dispensed per patient, with dates, age, sex, medical record number, diagnosis, amount collected, dosage, department/ward and prescribing physician The last Hb value was obtained for the computerised medical history records and the proportion of patients below and above the therapeutic range was estimated.

Results 139 patients, 61 women (43.9%) and 78 men (56.1%), between 21 and 101 years (mean 68.6). 48.9% (68) of the patients had an Hb within the therapeutic range (mean 11). 22.3% (31) had Hb less than 10 g/dl (mean 9.2 and minimum 6) while in 28.8% (40) it was greater than 12 (mean 13.2 and maximum 15.4).

Conclusions 71 patients (51%) had Hb outside the therapeutic range. It is necessary to monitor the haemoglobin levels to check the safety and efficacy of erythropoietin. It is essential to include all episodes and data in the computerised medical history.

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