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"documento" => "article" "crossmark" => 1 "subdocumento" => "rev" "cita" => "Med Clin. 2020;154:61-5" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:12 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Review</span>" "titulo" => "Whole body FDG-PET/CT for the assessment of bone marrow infiltration in patients with newly diagnosed lymphoma" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "61" "paginaFinal" => "65" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "FDG-PET/TC de cuerpo entero para evaluar la infiltración de la médula ósea en pacientes con linfoma de nuevo diagnóstico" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Wang Xiao-Xue, Huang Xinyue, Zhang Lijun" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Wang" "apellidos" => "Xiao-Xue" ] 1 => array:2 [ "nombre" => "Huang" "apellidos" => "Xinyue" ] 2 => array:2 [ "nombre" => "Zhang" "apellidos" => "Lijun" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2387020619305364?idApp=UINPBA00004N" "url" => "/23870206/0000015400000002/v2_202001231012/S2387020619305364/v2_202001231012/en/main.assets" ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Scientific letter</span>" "titulo" => "Effectiveness of outpatient treatment with intravenous iron in selected primary care patients" "tieneTextoCompleto" => true "saludo" => "Dear Editor," "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "66" "paginaFinal" => "67" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Laura Rivilla Marugán, Teófilo Lorente Aznar, José Antonio García-Erce" "autores" => array:3 [ 0 => array:3 [ "nombre" => "Laura" "apellidos" => "Rivilla Marugán" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 1 => array:3 [ "nombre" => "Teófilo" "apellidos" => "Lorente Aznar" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:4 [ "nombre" => "José Antonio" "apellidos" => "García-Erce" "email" => array:1 [ 0 => "jagarciaerce@gmail.com" ] "referencia" => array:3 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] 2 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Centro de Salud Sabiñánigo, Sabiñánigo, Huesca, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Banco de Sangre y Tejidos de Navarra, Pamplona, Navarra, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Grupo de Trabajo de la Sociedad Española de Transfusión Sanguínea «Hemoterapia basada en el sentido común», Spain" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Efectividad del tratamiento ambulatorio con hierro intravenoso en pacientes seleccionados de atención primaria" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Any approach to iron deficiency anaemia (IDA) should try to identify the cause while simultaneously initiate iron intake.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> As an alternative to the oral route, intravenous iron therapy (IIT) formulations are available and indicated in certain circumstances<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">2–5</span></a>: IDA refractory to oral iron or patients with intolerance to it, need for rapid iron supply in severe anaemias, active intestinal disease and for chronic kidney disease, when oral iron is less effective.</p><p id="par0010" class="elsevierStylePara elsevierViewall">There are two available IIT preparations: (1) carboxymaltose, more expensive, but allows us to administer 1000<span class="elsevierStyleHsp" style=""></span>mg per dose, and (2) hydroxy-sucrose, limited to 200<span class="elsevierStyleHsp" style=""></span>mg per dose. IIT is considered a medication for hospital use. However, primary care can also prescribe it, provided there is a fluid coordination with the reference hospital services. We present the cases of five patients with IDA, who were prescribed IIT from primary care to be administered in a referral hospital. Although the Ganzoni formula has traditionally been used to calculate the dose to be administered, the table in the data sheet was used, as it simplifies the calculations. Personal circumstances, availability and patient context were considered when choosing between the two preparations.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Patient 1: 42-year-old female, employed, consulted for asthenia. Analytical control test: Hb 8.5<span class="elsevierStyleHsp" style=""></span>g/dl and MCV 60.6<span class="elsevierStyleHsp" style=""></span>fl. Oral iron therapy was initiated (two ferrous sulfate capsules 105<span class="elsevierStyleHsp" style=""></span>mg/day). Two months later: Hb 10.5<span class="elsevierStyleHsp" style=""></span>g/dl and MCV 73.7<span class="elsevierStyleHsp" style=""></span>fl. 1000<span class="elsevierStyleHsp" style=""></span>mg of carboxymaltose IIT was prescribed at the Jaca Hospital. Analytical results at one month: Hb 13.7<span class="elsevierStyleHsp" style=""></span>g/dl and MCV 83.3<span class="elsevierStyleHsp" style=""></span>fl. Follow-up by the digestive dept.: only finding of interest, infection with <span class="elsevierStyleItalic">Helicobacter pylori</span>.</p><p id="par0020" class="elsevierStylePara elsevierViewall">Patient 2: 80-year-old female, consults due to upper gastrointestinal bleeding. Analytical control test: Hb 6.5<span class="elsevierStyleHsp" style=""></span>g/dl and MCV 83.2<span class="elsevierStyleHsp" style=""></span>fl. During admission she received a transfusion of two packed red blood cells (RBCs) and 400<span class="elsevierStyleHsp" style=""></span>mg of sucrose IIT. Discharged without outpatient care with Hb 8.8<span class="elsevierStyleHsp" style=""></span>g/dl and MCV 81.6<span class="elsevierStyleHsp" style=""></span>fl, and an appointment for two months’ time with the digestive dept. Two doses of 200<span class="elsevierStyleHsp" style=""></span>mg of sucrose were prescribed at the Jaca Hospital. Analytical results at one month: Hb 12<span class="elsevierStyleHsp" style=""></span>g/dl and MCV 90.9<span class="elsevierStyleHsp" style=""></span>fl.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Patient 3: 46-year-old male agricultural worker, with a history of severe relapsing IDA who had required a transfusion of one RBC and sucrose IIT during admission; no cause was found. Analytical control test: Hb 9.7<span class="elsevierStyleHsp" style=""></span>g/dl and MCV 67.9<span class="elsevierStyleHsp" style=""></span>fl. 1000<span class="elsevierStyleHsp" style=""></span>mg of carboxymaltose IIT was prescribed at the Jaca Hospital. Analytical results at one month: Hb 13.5<span class="elsevierStyleHsp" style=""></span>g/dl and MCV 79.8<span class="elsevierStyleHsp" style=""></span>fl.</p><p id="par0030" class="elsevierStylePara elsevierViewall">Patient 4: 93-year-old female patient. Consults due to haematuria and anaemisation. Diagnosis: bladder mass (surgical resection) associated with chronic myeloproliferative syndrome (therapeutic abstention due to patient's clinical fragility). Transfusion of two RBCs. Discharge without treatment. Analytical control test: Hb 8.3<span class="elsevierStyleHsp" style=""></span>g/dl and MCV 79.2<span class="elsevierStyleHsp" style=""></span>fl. 1000<span class="elsevierStyleHsp" style=""></span>mg of carboxymaltose iron was prescribed at the Jaca Hospital. Analytical results at one month: Hb 12.2<span class="elsevierStyleHsp" style=""></span>g/dl and MCV 79.1<span class="elsevierStyleHsp" style=""></span>fl.</p><p id="par0035" class="elsevierStylePara elsevierViewall">Patient 5: 48-year-old female who consulted because of asthenia. Analytical control test: Hb<span class="elsevierStyleHsp" style=""></span>3.7<span class="elsevierStyleHsp" style=""></span>g/dl and MCV<span class="elsevierStyleHsp" style=""></span>50.9<span class="elsevierStyleHsp" style=""></span>fl. When the patient is finally contacted after several unsuccessful attempts, she refuses to go to the hospital because it is ‘peak season’ at work. She also rejects a transfusion. The Haematology Service of the Huesca San Jorge Hospital is contacted and the patient is offered treatment with carboxymaltose IIT. The first dose of 1000<span class="elsevierStyleHsp" style=""></span>mg is administered at the Huesca San Jorge Hospital San Jorge and the rest at the Jaca Hospital. Gastroscopy showed a Forrest II ulcer. Analytical results at one month: Hb 10.7<span class="elsevierStyleHsp" style=""></span>g/dl and MCV 79.7<span class="elsevierStyleHsp" style=""></span>fl.</p><p id="par0040" class="elsevierStylePara elsevierViewall">In all cases, there was an Hb increase of more than 3<span class="elsevierStyleHsp" style=""></span>g/dl one month after treatment, and no documented adverse reaction. IIT carboxymaltose on an outpatient basis was chosen because of the possibility of administering it in a single dose for many cases, achieving an early replacement. This prevents the patient form having to travel of more than 70<span class="elsevierStyleHsp" style=""></span>km to the general hospital of reference and take time off work and saves on healthcare-related transport costs.</p><p id="par0045" class="elsevierStylePara elsevierViewall">We believe that for certain patients, high doses of IIT can prevent or reduce the number of transfusions and hospital admissions, the need for travel and days off work, and health costs. Its indication from primary care is an effective and safe alternative. Studies are needed to validate its administration in primary care centers as well as in the emergency department.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a></p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Rivilla Marugán L, Lorente Aznar T, García-Erce JA. Efectividad del tratamiento ambulatorio con hierro intravenoso en pacientes seleccionados de atención primaria. Med Clin (Barc). 2019;154:66–67.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0030" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Guidelines on the diagnosis and treatment of iron deficiency across indications: a systematic review" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "L. Peyrin-Biroulet" 1 => "N. Williet" 2 => "P. 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García-Erce" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.2450/2017.0282-16" "Revista" => array:6 [ "tituloSerie" => "Blood Transfus" "fecha" => "2017" "volumen" => "15" "paginaInicial" => "438" "paginaFinal" => "446" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28151394" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/23870206/0000015400000002/v2_202001231012/S2387020619305297/v2_202001231012/en/main.assets" "Apartado" => array:4 [ "identificador" => "43311" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Scientific letters" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/23870206/0000015400000002/v2_202001231012/S2387020619305297/v2_202001231012/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2387020619305297?idApp=UINPBA00004N" ]
