What is the best way to treat a 60yr old male with blood count of 4.4? I have been told EPO only works in 50% of cases. Any help much appreciated.

That is a very general statement in my opinion.

If you know why the patient has the anemia (blood loss due to surgery, GI bleed etc) you can correct the anemia with several available products other then transfusion. If the reason for the anemia is unknown, then your patient will need a blood workup and possibly a hematologist consult to investigate and see if he has a problem.

At our facility we do the following to correct anemia:

1. Stop the bleeding
2. Reduce iatrogenic blood loss
3. Give therapy for hematinic deficiencies:
i.v. iron, Folic Acid, Vitabin B12 and EPO (for severe anemia for rapid restoration of red cell mass)
4. Nutritional support (oral/parenteral)

This is obviously in addition to other items and therapy like oxygen and fluid support when needed.

You can find more info on this site on the correction of anemia and by doing a google search.
ap

Here's something from St Jude's Children's Research Hospital.

I recommend contacting Doctor Patricia Ford at Philadephia Hospital - http://www.noblood.org/wiki/index.ph...icia_A_Ford_MD

Michael Columbus works with her - http://www.noblood.org/wiki/index.ph...ael_J_Columbus


Disease Information

Leukemias / Lymphomas: Myelodysplasia (MDS)

Alternative Names: MDS

Definition



Myelodysplasia (MDS) refers to a group of disorders in which the bone marrow does not function normally and produces insufficient number of normal blood cells.

MDS affects the production of any, and occasionally all, types of blood cells including red blood cells, platelets, and white blood cells (cytopenias).

About 50 percent of pediatric myelodysplasia can be classified in five types of MDS: refractory anemia, refractory anemia with ring sideroblasts, refractory anemia with excess blasts, refractory anemia with excess blasts in transformation, and chronic myelomonocytic leukemia.

The remaining 50 percent typically present with isolated or combined cytopenias such as anemia, leucopenia and/or thrombocytopenia (low platelet count). Although chronic, MDS progresses to become acute myeloid leukemia (AML) in about 30 percent of patients.



Incidence

• Fewer than 100 new cases of myelodysplasia are reported in the United States each year in children.
• MDS is found most often in adults over the age of 50 (median age 65 years old), but is also seen in children of all ages.

Influencing Factors

• There is a slightly higher incidence of myelodysplasia in males than in females.
• Genetic and environmental factors have been implicated in the etiology of MDS. Exposure to excessive radiation, some toxic chemicals, certain medicines, and viral infections may cause MDS in some people.

Survival Rates



Up to 60 percent of patients that receive bone marrow transfusions achieve long-term survival.



Treatment Strategies

• Allogeneic hematopoietic stem cell transplantation (transfusions using marrow, peripheral blood or cord blood from a compatible donor) is the most effective form of treatment for most types of myelodysplasia.
• Chemotherapy is a form of treatment for some patients with a high risk of MDS progressing into AML.
• Supportive treatments include blood and platelet transfusions and antibiotics.

Current Research



Most St. Jude myelodysplasia patients are enrolled on our front-line AML or hematopoietic stem cell transplantation protocols.

__________________
Mr. Jan B. Wade
Blood Management Consultant
Enhance Outcomes - Control Cost
For Information Call - 360 296-1807
Email

My sincere thanks to Jan and Alexander for their very speedy, helpful comments

Ken McGuire