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EVIDENCE-BASED NURSING

Present Practice Treating Anemia with Red Blood Cell Transfusions When anemia becomes severe, generally when hemoglobin drops to or below 7-8 g/dL transfusions are often used to quickly raise hemoglobin levels to a normal range and reduce symptoms like significant fatigue and dizziness. Blood transfusions, however, do come with some risks. For instance transfused blood can introduce pathogens directly into the blood stream, can lead to possibly fatal reactions, or can cause changes in the patients immune system that may lead to other serious reactions and infections. Additionally, several studies have shown that patients who receive transfusions, on average, stay in the hospital longer, have higher hospital bills, and are generally more ill than patients who did not receive a transfusion.

Evidenced-Based Nursing New drug to treat anemia The name of the drug is FG-2216, and its designed to stimulate production of the hormone erythropoietin (EPO) in dialysis patients. In fact, its the worlds first oral drug for the treatment of kidney disease-related anemia; its a hypoxia inducible factor prolyl hydroxylase inhibitor (HIF-PHI) that stabilizes the "master switch," which normally tells the body to produce EPO in response to low oxygen levels. Anemia, one of the more common blood disorders, is caused by low production of EPO, which has been assumed to result from damage to the kidney cells that produce EPO. "Our study clearly shows that this may not be the case, and that the kidneys of patients on dialysis retain significant ability to produce erythropoietin," which Wanja M. Bernhardt, MD, Department of Nephrology, University hospital Erlangen, Germany, was quoted as saying. "Renal anemia seems to result from disturbed regulation rather than lost production capacity of the hormone. Treatment with FG-2216 considerably increased EPO production in dialysis patients, in addition to healthy people with normal kidneys. The utmost

Recommendations to Present Practice Because of the risks present in blood transfusion the nurse should perform the following:

Verify that an order for the transfusion exists. Conduct a thorough physical assessment of the patient (including vital signs) to help identify later changes. Document findings. Confirm that the patient has given informed consent. Teach the patient about the procedures associated risks and benefits, what to expect during the transfusion, signs and symptoms of a reaction, and when and how to call for assistance. Check for an appropriate and patent vascular access. Make sure necessary equipment is at hand for administering the blood product and managing a reaction, such as an additional free I.V. line for normal saline solution, oxygen, suction, and a

increase in EPO production occurred in dialysis patients whose kidneys were still present, but no longer functioning. FG-2216 additionally stimulated EPO production in dialysis patients with no kidneys. These are individuals whose kidneys had been removed at surgery for cancer or other diseases. The significant increase in EPO production in patients devoid of kidneys was approximately as high as in people with normally functioning kidneys. In patients with no kidneys, FG-2216 in fact stimulated production of EPO by the liver. The studys outcome questions the standard knowledge that dialysis-related anemia occurs for the reason that patients with advanced kidney disease can no longer make their own EPO. "Our results confirm that both the liver and the kidneys retain a significant production capacity for erythropoietin in end-stage renal disease patients," adds Bernhardt. Presently, patients with dialysisrelated anemia are given EPO replacement therapy with drugs called erythropoiesis-stimulating agents (ESAs). Regardless of nearly two decades of use, there remains a constant debate related to the safety, appropriate clinical use, and in due course high costs of ESAs. If the latest results are borne out by future studies, then use of prolyl-hydroxylase inhibitors such as FG-2216 to help the body make its own EPO might provide a new-fangled alternative to ESAs.

hypersensitivity kit. Be sure you're familiar with the specific product to be transfused, the appropriate administration rate, and required patient monitoring. Know what personnel will be available in the event of a reaction, and how to contact them. Resources should include the oncall physician and a blood bank representative. Before hanging the blood product, thoroughly doublecheck the patients identification and verify the actual product. Check the unit to be transfused against patient identifiers, per facility policy. Infuse the blood product with normal saline solution only, using filtered tubing.

The groundwork has been set with this study, which moreover evaluated merely the response to a single dose of FG-2216. Although there were no harmful effects, the results and long-term safety of activation of HIF by prolylhydroxylase inhibitors remain uncertain. Additional research will furthermore be required to find out why HIF is evidently not stabilized in response to decreased oxygen concentrations in patients with kidney disease but responds to treatment with prolyl-hydroxylase inhibitors. SOURCE: Journal of the American Society of Nephrology, November 29, 2010

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