Unique Plan Description: Anemia
Plan Selection Display: Anemia
PlanType: Medical                                 
Version: 2          
Begin Effective Date: 2020-04-19 11:53:00
End Effective Date: 2100-12-31 00:00:00
Last Updated Date: 2025-07-01 13:09:44
Available at all facilities: Yes

Anemia
Vital Signs
	Vital Signs
		Per protocol
Laboratory
		Serum iron, total iron binding capacity (TIBC), and serum ferritin should be assayed at baseline in all anemic patients who are being considered for an erythropoiesis-stimulating agent (ESA).(NOTE)*
	Reticulocyte Count
		Stat, spec type = Blood
	ESR
		T;N, Routine, spec type = Blood
	UA (Culture if Positive)
		T;N, Routine, Routine, UA Cult Clean Catch, Midvoid, spec type = Urine
	Hemoglobin and Hematocrit
		Routine, Q6H, spec type = Blood
		Routine, Q8H, spec type = Blood
	Peripheral Smear Consult
		T;N, Routine HEMATO, Routine
	CBC with Diff
		T+1;0400, Routine, spec type = Blood
	Ferritin
		Stat, spec type = Blood
	Transferrin Profile
		Routine, spec type = Blood
	Iron Panel - MH/WH/JE
		Stat, spec type = Blood
	Direct Coombs
		Stat, spec type = Blood
	LD
		Stat, spec type = Blood
	Bilirubin Total
		Routine, spec type = Blood
	Comprehensive Metabolic Panel
		Stat, spec type = Blood
	Haptoglobin
		Stat, spec type = Blood
	Occult Blood Stool - MH/WH/FH
		Routine, spec type = Stool
	Occult Blood Stool - JE
		Routine, spec type = Stool
	Occult Blood Stool X3 - MH/WH/FH
		Routine, spec type = Stool
	Vitamin B12 Level
		Stat, spec type = Blood
	Folate
		Stat, spec type = Blood
		Red blood cell (RBC) transfusion is an appropriate alternative for patients whose clinical condition indicates the need for immediate correction of the hemoglobin level, for those in whom reducing the frequency of transfusion is not an important considera(NOTE)*
	Type and Crossmatch (Product Available)
		T;N, Stat, For Possible Transfusion
		T;N, Routine, For Possible Transfusion
Medications
		Cancer patients who are being considered for treatment with erythropoiesis-stimulating agents (ESA) should meet all of the following criteria: symptomatic anemia due to chemotherapy for a non-hematologic malignancy, other treatable causes of anemia should(NOTE)*
		In general, UpToDate suggests the use of erythropoiesis-stimulating agents (ESAs) rather than transfusion for patients who meet all of the above criteria, and who do not have a heightened risk for thromboembolic events (eg, prior history of thromboses, su(NOTE)*
		The approved starting dose of epoetin is 150 U/kg three times weekly or 40,000 U weekly, subcutaneously; the approved starting dose for darbepoetin is 2.25 microgram/kg weekly or 500 micrograms every three weeks, subcutaneously.(NOTE)*
		Physicians that prescribe EPO for cancer must be registered with ESAppraise(NOTE)*
	Procrit
		50 units/kg, Solution, SUBCUTANEOUS, MonWedFri
			Comment: Round to nearest vial size
		150 units/kg, Solution, SUBCUTANEOUS, MonWedFri
			Comment: Round to nearest vial size
		40,000 units, Solution, SUBCUTANEOUS, Once, T;N
	Procrit (ESRD on Dialysis)
		50 units/kg, Solution, SUBCUTANEOUS, MonWedFri
			Comment: Round to nearest vial size
		150 units/kg, Solution, SUBCUTANEOUS, MonWedFri
			Comment: Round to nearest vial size
		40,000 units, Solution, SUBCUTANEOUS, Once, T;N
			Comment: Round to nearest vial size
	Aranesp (ESRD)
		2.25 mcg/kg, Injection, SUBCUTANEOUS, Once, T;N
			Comment: Round to nearest vial size
		500 mcg, Injection, SUBCUTANEOUS, Once, T;N
		For all patients treated with erythropoiesis-stimulating agents, UpToDate recommends that supplemental iron be given to maintain a transferrin saturation greater than or equal to 20 percent and a serum ferritin greater than or equal to 100 ng/mL (Grade 1B(NOTE)*
		Clinicians contemplating the use of intravenous iron preparations should be fully conversant with requirements for a test dose, rates of infusion, maximum allowed doses, and the need, if any, for premedication. The use of antihistamines for premedication(NOTE)*
	Vitamin C
		500 mg, Tab, By Mouth, BID
			Comment: Give with Iron
		500 mg, Tab, By Mouth, DAILY
			Comment: Give with Iron
	ferrous sulfate
		325 mg, Tab, By Mouth, BID
			Comment: Give with Vit C
		325 mg, Tab, By Mouth, DAILY
			Comment: Give with Vit C
		325 mg, Tab, By Mouth, TID
			Comment: Give with Vit C
	Venofer IVPB
		200 mg, INT, IVPB, DAILY, 3 Day(s)
	Feraheme
		510 mg, INT, IVPB, Once, T;N
	sodium ferric gluconate complex
		125 mg, INT, IVPB, Once, infuse over 1 hr, T;N
		250 mg, INT, IVPB, Once, infuse over 2 hr, T;N
	ferrous sulfate
		325 mg, Tab, BY MOUTH, BID
		325 mg, Tab, BY MOUTH, DAILY
	folic acid
		1 mg, Tab, BY MOUTH, DAILY
	Vitamin B-12
		1,000 mcg, Tab, BY MOUTH, DAILY
		1,000 mcg, Injection, IM-IntraMUSCULAR, DAILY
	pantoprazole IV
		40 mg, Injection, IV Push, BID
	Protonix
		40 mg, Tablet-Enteric-Coated, BY MOUTH, BID
		Those with asthma or more than one drug allergy are more likely to experience a minor infusion reaction to IV iron. UpToDate routinely premedicates these patients with 125 mg of intravenous methylprednisolone. This recommendation applies to all of the int(NOTE)*
		In the absence of a history of asthma or more than one drug allergy, UpToDate strongly recommends that premedication not be given.(NOTE)*
	SOLU-Medrol
		125 mg, Injection, IV Push, Q12H
Patient Care
	Notify MD
		if patient is on any the following: asa, plavix, coumadin, heparin, lovenox, NSAIDs.
	Patient Education
		T;N, Instructions: Anemia
Consults/Follow-up
	Consult Hematologist/Oncologist
		Reason for Referral: Anemia
	Consult Gastroenterologist
		Reason for Referral: Anemia

Transfuse (Administer) Blood Products EKM
Vital Signs
		Refer to Transfusion Guidelines for Blood Components(NOTE)*
	Vital Signs
		T;N
			Comment: VS within 30 minutes before starting the transfusion, within 5-15 minutes after starting infusion, whenever a suspected adverse reaction occurs, and within 30 minutes of when transfusion complete
Laboratory
Packed Cells
	Crossmatch Red Blood Cells
		T;N, Routine
		T;N, Stat
	Administer blood products
		T;N, Packed cells
Plasma
	Frozen Plasma
		T;N, Routine
	Administer blood products
		T;N, Plasma-fresh frozen
Platelet Pheresis
	Platelet Pheresis
		T;N, Routine
	Administer blood products
		T;N, Platelet
Cryopreciptate
	Cryoprecipitate
		T;N, Routine
	Administer blood products
		T;N, Cryoprecipitate
IV Solutions

	Sodium Chloride 0.9%
		500 mL, IV, 1 Dose(s)/Time(s), 20 ml/hr
Medications
	Tylenol
		650 mg, Tab, By Mouth, Once, T;N
Patient Care
	Obtain Consent/Permit for:
		T;N, blood product transfusion
	Patient Education
		T;N, Review education leaflet "When you need a blood transfusion" prior to administering blood.
	Notify MD
		T;N, Temperature >100.0 F prior to transfusion

Coagulation Panel
Laboratory
	.Protime - MH/WH/JE
		T;N, Stat, spec type = Blood
	Prothrombin Time (PT) - FH
		T;N, Stat
	PTT - MH/WH/JE
		T;N, Stat, spec type = Blood
	Partial Thromboplastin Time (PTT) - FH
		T;N, Stat, spec type = Diagnostic Blood
	Fibrinogen Level - MH/WH/JE
		T;N, Stat, spec type = Blood
	Fibrinogen Level - FH
		T;N, Stat, spec type = Blood
	Platelet Count
		T;N, Stat, spec type = Blood

*Report Legend:
DEF - This order sentence is the default for the selected order
GOAL - This component is a goal
IND - This component is an indicator
INT - This component is an intervention
IVS - This component is an IV Set
NOTE - This component is a note
Rx - This component is a prescription
SUB - This component is a sub phase