肾性贫血治疗指南.ppt

3.4.: TRANSFUSION THERAPY 3.4.1 In the opinion of the Work Group, no single Hb concentration justifies or requires transfusion. In particular, the target Hb recommended for chronic anemia management (see Guideline 2.1) should not serve as a transfusion trigger. 单纯的Hb降低不作为输血的理由，不能为了Hb达标而输血。 慢性贫血患者输血是为了防止组织缺氧或心力衰竭。 在ESA 治疗Hb 达标的患者，仅在急性失血(如急性出血、急性溶血、严重炎症或外科血液丢失)时输血。 输血患者患急性冠脉综合征时有更高的死亡率。 3.5. EVALUATING AND CORRECTING PERSISTENT FAILURE TO REACH OR MAINTAIN INTENDED HB 3.5.1 Hyporesponse to ESA and iron therapy: In the opinion of the Work Group, the patient with anemia and CKD should undergo evaluation for specific causes of hyporesponse whenever the Hb level is inappropriately low for the ESA dose administered. Such conditions include, but are not limited to: ● A significant increase in the ESA dose requirement to maintain a certain Hb level or a significant decrease in Hb level at a constant ESA dose. ● A failure to increase the Hb level to greater than 11 g/dL despite an ESA dose equivalent to epoetin greater than 500 IU/kg/wk. rHuEPO 治疗的低反应性（EPO 抵抗） 定义：皮下注射rHuEPO 达到300IU/Kg/W(20000IU/W)或静脉注射rHuEPO 达到500IU/Kg/W(30000IU/W)治疗4 个月后，Hb 仍不能达到或维持靶目标值，称为EPO 抵抗。 最常见的原因是铁缺乏，其它原因包括： ☆炎症性疾病 ☆慢性失血 ☆甲状旁腺功能亢进 ☆纤维性骨炎 ☆铝中毒 ☆血红蛋白病 ☆维生素缺乏 ☆多发性骨髓瘤 ☆恶性肿瘤 ☆营养不良 ☆溶血 ☆透析不充分 ☆ACEI/ARB 和免疫抑制剂等药物的使用 ☆脾功能亢进 ☆EPO 抗体介导的纯红细胞再生障碍性贫血（PRCA） CPR 3.5. EVALUATING AND CORRECTING PERSISTENT FAILURE TO REACH OR MAINTAIN INTENDED HB 3.5.2 Evaluation for PRCA: In the opinion of the Work Group, evaluation for antibody-mediated PRCA should be undertaken when a patient receiving ESA therapy for more than 4 weeks develops each of the following: ● Sudden rapid decrease in Hb level at the rate of 0.5 to 1.0 g/dL/wk, or requirement of red blood cell transfusions at the rate of approximately 1 to 2 per week, AND ● Normal platelet and white blood cell counts, AND ● A