Click here for an explanation of these scores
Answer Rating key
|
search
|
|
strong
|
|
appraisal
|
|
weak
|
|
confidence
|
|
moderate
|
Question answered:29/04/08
Given that the anaemia is only assumed we felt it important to highlight a warning in the SPC for Cobalin H injection, in section 4.4:
“Cobalin-H should not be given before a megaloblastic marrow has been demonstrated. Regular monitoring of the blood is advisable. Doses of hydroxocobalamin greater than 10 micrograms daily may produce a haematological response in patients with folate deficiency. Indiscriminate use may mask the exact diagnosis. Cardiac arrhythmias secondary to hypokalaemia have been reported during initial therapy and plasma potassium should, therefore, be monitored during this period.”
Section 9 discusses overdose and states:
“Treatment is unlikely to be needed in cases of overdosage.” [1]
CKS (formerly PRODIGY) have produced a guideline on the management of B12 anaemia and folate deficiency and this contains a substantial section on diagnosis (covering signs, symptoms and investigations for diagnosis) at: http://www.cks.library.nhs.uk/anaemia_b12_and_folate_deficiency#-314268
The guideline also has a section on when to refer patients to secondary care: http://www.cks.library.nhs.uk/anaemia_b12_and_folate_deficiency/management/detailed_answers/referral
References
1. SPC for Cobalin H injection. 2002. (http://emc.medicines.org.uk/emc/industry/default.asp?page=displaydoc.asp&documentid=8173)
2. CKS. Anaemia B12 and folate deficiency. April 2008. (http://www.cks.library.nhs.uk/anaemia_b12_and_folate_deficiency/)
DISCLAIMER: TRIPanswers is a collection of clinical questions and answers. Each provider will have their own methodology in answering questions and these are likely not to be as rigorous as systematic review. If you have any doubt as to the implications of this contact the Q&A Service Provider for further information. This document is presented for information purposes only. This document cannot and should not be used as a basis of diagnosis or choice of treatment, and is in no way intended to replace professional medical care or attention by a qualified practitioner. TRIPanswers and TRIP Database Ltd are not responsible or liable for, directly or indirectly, ANY form of damage whatsoever resulting from the use/misuse of information contained in or implied by this document. Also, ensure you have read the terms and conditions for using the site.