2013 Jan 20                                     http://ncad.net/health/FeOver/patient.htm

The number one political topic today is healthCare, due to its ironically cancerous role in our number one global concern - the Economy.

Here we file a Report of one patient encounter, from which many lessons may be learned by and for all of us.

 

For easy reference, open the Bibliography  to view numbered references in the Report.

Contents

Report of and Solution for neglected Patient 4pages

graph of blood data  (updated as new data arises)

graph of iron data  (primarily tracking Ferritin, data is divided by 10 to fit on graph) 

Normal ( 60 - 300 ) /10 = ( 6 - 30 )

2012 June 13 - A new graph line is provided for indication of renal function. crea00 is the serum Creatinine (desirably lower than 1), normalized by multiplying by 100.

 

Progress Update  After 83 iron poisoning transfusions, perhaps responsive to this Report, Patient was finally granted relief by simultaneous deferoxamine IV during transfusions 84-86, and 3 weeks later during 87-88.  However, based on clinical evidence, we questioned the potency of these initial deferoxamine administrations.  On May 2, VA Oncology/Hematology pharmacist stated all subsequent administrations would use Novartis Desferal brand deferoxamine mesylate (Dfo).

The current treatment goal is 24hr/day continuous subcutaneous infusion, achieving 28mg/kg/day (2g/day) continuous Novartis Desferal via I-FLOW HOMEPUMP ECLIPSE part# C270010, renewed weekly.  This goal was nearly achieved prior to learning about the extreme diuretic (dehydrating) effect of deferoxamine (Dfo) administration.

2012

Mar 23 16:00  Transfusions 84-86. 3G Dfo

Apr 05 16:00  iflo #1 started; suspended 24 hours beginning Apr 10 20:00 during

Apr 11 16:00  Transfusions 87-88; 2G Dfo;   continuous subCu resumed 20:00.

Apr 12 20:00  iflo #2 started.

Apr 19 11:00  blood data:  Based on well-established pattern of declining hemoglobin .6/wk, expected 9.0; actual was 10.1.  Subsequent data indicates this was anomalous.

Apr 21 09:00  iflo #3 started.

Apr 28 11 00  iflo #4 started.

Apr 30 11:00  following insufficiently taking OPCs > reported slight dyschromatopsia resolved by OPCs while iflo was stopped for 3 hours.

May 02 16:00  Transfusions 89-90; 2G Desferal, subsequent to report of hemoglobin 8.3.  Ferritin 2693.  On Apr 19, Ferritin 2932.  Infer: Apr 05: 3272.

May 04 23:00 iflo #5 started.

May 12 14:00 iflo #6 started.  Stopped on May 19.  Temporarily not resumed.

May 17 09:00 blood draw; Hgb 9.3, consistent with vascular fluid decline.

May 23 16:00 Patient found to be dehydrated (water leaving with iron) which caused false readings for hemoglobin.

May 24 11:44 updated data reflects impact of dehydration and/or deferoxamine on kidney function.  Creatinine 141.

May 25 noon  Transfusions 91-92; no deferoxamine provided.

May 27 Patient enjoyed day with family and good nutrition, conversing late, excitedly...

May 28 ...and arising to converse more at 7:14am, happy for new day!

June 01 good lab report; no leukemia

June 06 almost identical report, reflecting 5-day hemoglobin loss of .3.

June 12 Transfusions 93-94; no Dfo.  Creatinine 115  Appeal for Continuation of Treatment upon stable kidney function (normal Creatinine)

July 03  Transfusions 95-96, no Dfo.

July 19  Transfusions 97-98, 1g Dfo;  Novartis recommendation:  2g/Unit = 4g.  Creatinine 84.

Also note increasing healthy absence of leukemia; and normal healthy values for liver enzymes:  ALT, AST, Alkaline Phosphatase.

July 26  Started 1g/day Dfo.

Aug 08  Completed 2 weeks of 1g/day Dfo (Deferoxamine). Iflo #7-8.  Today start #9.  iflo # 1-6 were 2g/day Dfo.

Aug 15  Hg 6.1 > Transfusions 99-100.  iflo #10 started.

Aug 16  Transfusion 100.  Ferritin 2186; see graph of iron data.

Aug 19  Support stockings... have yielded positive results, resulting in lower weight due to decreased fluid retention below knees.

Aug 21  Started iflo #11, 1g/day.

Aug 28  Started iflo #12, 1g/day.

Sep 05  Dehydrated.  Wt 140lb.  Transfusion 101.  Creatinine 1.38

Sep 06  Transfusion 102.  Creatinine 1.26, (over 1.00 - requiring temporary cessation of Dfo.

2013

Jan 20  Report is updated to 4 pages.  Creatinine has consistently fallen; on Jan 17:  0.77.  See graphs above.

 

Bibliography

__0 - Wiki graphic indicating pathways leading to desired leukemic cell death (apoptosis).

__1 - 2009 report of mechanisms leading to leukemic cell apoptosis by grape seed extract (GSE) (active ingredient:  Oligomeric ProanthoCyanidins (OPCs)

__2 - textbook:  Neurodegeneration Chapter 9 - Iron

__3 - effect of iron overload on red blood cell formation

__4 - effective treatment of iron overload is associated with improved red blood cell formation

__5 - decreased morbidity when patients are treated for iron overload

__6 - the classic how-to guide for administering the natural iron chelator to relieve iron overload

__7 - updated survey of iron chelation therapy options

__8 - deferoxamine is universal, natural mechanism to get iron from earth.

__9 - 2011  FDA Orange Book on drugs, 2 of 1252 pages

_10 - 2011 08  FDA updated revision of Prescribing Information on new, patented drug Exjade

_11 - 2010 02 17  FDA Letter to Doctors  IMPORTANT DRUG WARNING

_12 - 2011 09 14  FDA review of New Drug Application Ferriprox

_13 - 2005 09 29  FDA review of New Drug Application Exjade

Novartis Desferal deferoxamine mesylate

    Desferal Prescribing Information

floDo

I-FLOW

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