Prophylactic administration of hematinics (iron, folic acid, vitamin B12) should always be considered.

 1- Treatment of iron deficiencies

– Intravenous (IV) iron by saline infusion, for example, iron hydroxide saccharate (dosage of 3 to 5 mg/kg/day and the maximum of 200 mg/day) or carboxymaltose (dosage 15 mg/kg and maximum of 1,000 mg in single infusion) can rapidly replenish iron reserves.

– Oral iron: sacarato de hidróxido férrico (200 mg/day) ou glicinato férrico (300-500 mg/day).

 2 – Recombinant human erythropoietin (r-Hu-EPO) therapy

– Standard dose in adult: 600 IU / kg / week. For example: Patient of 70 kg, apply intravenous 42,000 IU / week after dilution in 50 ml of SF 0.9%.

– Higher doses in adult: 150-300 UI / kg in intervals of 24-72 hours: poor response to erythropoiesis-stimulating therapy includes iron deficiency as well as infectious, inflammatory or malignant processes, occult blood loss, hyperparathyroidism and hematologic diseases

– Dose in children: 200 IU / kg /day (1,400 IU / kg/ week in divided dosages) has been shown to be safe and well tolerated by children.

For severe acute anemia, critical illnesses, deficiency in subcutaneous absorption (due to edema or blood flow alterations) consider initial IV administration of r-Hu-EPO followed by subcutaneous dosages.

Aggressive anemia therapy must not be delayed until the hemoglobin levels fall and reach critically low levels.


Anemia Treatment and Erythropoietin therapy Guidelines

Protocol based on scientific evidence for the non-transfusional treatment of anemia through the appropriate use of iron and erythropoietin.