Debbie;

Doesn't sound good. Is her cirrhosis is presently quiet? Meaning, if her liver enzymes are presently not elevated you can possibly recommend a consideration of Sodium Ferric Gluconate IV in half doses but with extreme caution. If she needs valves done and has active disease she will also need to be considered for Novoseven (no albumin) preapproval on reserve. She might be a candidate for cryo back up but if she refuses albumin she surely will refuse cryo. Sad because you don't have a lot of options here. If she is a valve redo, you have even more problems. Her beginning crit isn't bad but with her liver involvement her risk of coag problems are endless. A big challenge for a CV surgeon. Sorry.

Trudi,

I don't have recent liver enzymes. We are consulting a hepatologist regarding the iron issue. I am investigating Eprex as an option to raise Hgb. The CV surgeon doesn't have a problem taking him to OR if counts are up and will have NovoVII on reserve. The first hurdle is expanding his red cell mass.

Thanks for your input.

Debbie

Debbie,

I believe Aranesp can be obtained in the US without albumin.

Todd

Todd,

Thanks. I'll check with Amgen.

The insert for Aranesp (darbepoetin alfa) from Amgen reads:
"Aranesp is available in 2 solutions, an albumin solution and a polysorbate solution. The words "Albumin Free" appear on the polysorbate container labels and the package main panels..."

If you send me your fax number I can fax you this sheet.
ap

The fax number is 216-694-4614. Thank you.

__________________
Alysha Fuller
RN Coordinator
St. Vincent Charity Hospital
Regional Center for Blood Conservation
Cleveland, Ohio

FYI:

I checked with Amgen and aranesp's polysorbate solution or albumin free product is not available in the USA. It is on their package insert information because they had originally planned on having that configuration approved by the FDA but that did not occur. The albumin free product is available outside of the US. There are no plans at this time for FDA approval of that configuration.

I have been informed that you can obtain albumin-free EPO (Eprex) from Canada, Europe or S. Africa by contacting a physician in one of those countries who is willing to write a Rx for the drug. (Canada may be your best choice as the family could drive or arrange the Rx through one of the druggist over the border.) One of the branch offices for Jehovah's Witnesses may be able to help you with the process. This also applies to the blood substitutes that are used in other countries. However, the family needs to understand they are responsible for the cost and postage.

Sharon,

Thank you for your input. I just reviewed this option with the patient yesterday.