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Specimens must be collected in robust screw-capped and leak proof containers which will stand upright antibiotics for urinary tract infection uk discount 375 mg augmentin with amex. Full instructions should be given to do antibiotics for uti cause yeast infections buy augmentin 375 mg lowest price the amahs and attendants (porters) about action in case of an accident with an inoculation-risk specimen virus warning discount 375mg augmentin overnight delivery. Test should wherever possible be confined to zyvox antibiotic resistance buy augmentin master card those which can be performed in an enclosed system. Note: If the apparatus required servicing preliminary disinfection of the entire system will be necessary. Wherever possible, tissues should be received in the laboratory as small specimens in fixative. For small biopsy specimens, 6-8 hours in formaldehyde solution would suffice and this time interval should satisfy most diagnostic needs. When a more rapid result is required other methods of fixation, such as the use of heated formaldehyde solution, may suffice. Post-mortem examinations are carried out for medicolegal purposes or clinical reasons at the medico-legal discretion of the Pathologist. All glassware should be decontaminated by autoclaving at 121 ?C for 10 15 minutes or heat treated at 160 ?C for one hour prior to discarding the contents. If there is no working sewer, treat potentially contaminated liquid wastes the same as solids. Sharp instruments and needles should be put in a puncture resistant container to be disposed of by incineration. The theatre/labour ward staff (and Infection Control Team) should be informed so that appropriate preparations can be made: i. An adequate supply of hypochlorite and a new sharps disposal container should be ordered. The sharps container should be sealed and disposed of as soon as possible after the procedure. Disposal of abdominal swabs: there should be minimal handling; the contaminated (blood-soaked) swabs should be discarded by the surgeon into individual plastic bags, this will facilitate weighing and counting. Where possible avoid electrical and other delicate equipment, which is difficult to sterilize. All disposable, incineratable waste should be removed in clearly labelled colour-coded bags. Send respiratory equipment for heat or 2 per cent glutaraldehyde disinfection (label clearly). This is sufficent unless heavy soiling has occurred, when they should be wiped over with hypochlorite. All babies born to hepatitis B surface antibody positive mothers should be immunized against hepatitis B within 48 hours of birth. Wear protective clothing (gloves and disposable gowns) when handling blood and body fluids. Protective clothing should be disposed of in a clinical waste bag within the cubicle. If private facilities are available with the cubicle, the bowl should be cleaned and wiped over daily. If facilities are not available then a bedpan should be provided, which should be immediately emptied and disinfected in the bedpan disinfector. The outer surfaces of the renal dialysis machine should be cleaned with warm water and detergent. The inside of the machine should be cleaned with 1 per cent chloro (hypochlorite) and rinse thoroughly before further use. Equipment to be recycled should be able to withstand autoclave temperatures of 121? However, dental procedures often result in small amounts of blood mixing with oral fluids. Wear a mask and eye covering when splashes of blood or fluids containing blood are likely. Sterilize or disinfect instruments after use with each patient and clean surfaces with a suitable disinfectant. All sharp instruments and equipment, including needles and syringes, must be disposed of in puncture-resistant containers. Housekeepers and cleaners should carry waste in containers which are small enough to be easily held away from the body to avoid injuries. If no leak-proof containers are available, fold the linen with the wet parts inside, and surround with dry linen for carrying. Wash laundry in hot water (at least 71 degrees Centigrade or 160 degrees Fahrenheit). If only cold water is available, use special chemical detergents for this purpose or add bleach. However, persons handling dead bodies of confirmed or suspected cases should take all possible care to prevent blood, blood products or body fluids from coming into direct contact with their skin and mucous membrane. It is important for all health care workers to respect the different religious and cultural practices and traditions concerning the handling of dead bodies. If there is danger of fluid spillage such as when disinfecting or washing the body, the attendant should wear in addition, a mask, waterproof apron and boots. Further, they must wash their hands thoroughly with soap and water aft er the procedures. If the relatives request to see the body, they should be allowed but must be strongly discouraged from embracing or kissing it. Notify the Medical Assistant in charge of the mortuary who will inform the District Health Officer of the death. The next-of-kin of the deceased is also to be informed immediately of the death and that burial is required to be done within 24 hours. The assistance of the nearest police station should be duely sought if the next-of-kin could not be directly contacted. Place the body in a translucent body bag and transport it to the mortuary room on a steel top trolley for subsequent disinfection. Soiled linen should be handled as little as possible and with minimal agitation to prevent gross microbial contamination of the air and of person handling the linen. All the soiled linen should therefore be bagged, properly labelled and sent to the laundry where they are first disinfected with sodium hypochlorite for 1/2 hour before being washed. Stretcher trolley, bed and other formites that come in contact with the body/body fluids must be immediately disinfected with sodium hypochlorite. All clothings worn by the deceased are removed and soaked in sodium hypochlorite for at least 1/2 hours. The body is first washed with sodium hypochlorite and then followed by rites of the respective religions. The washing is to be done by representatives of the religious department/relatives under direct supervision of the health personnel. Cleaning of the oral cavity or other orifices should be done with the assistance of a sponge holder (forceps) or other suitable instrument. Bodies with open wounds due to accidents or with skin lesions should be wrapped in cloth and put in a translucent body bag. In the case of a Muslim, white cloth is used and the body further wrapped twice more in white cloth. The body can then be transported in a coffin made of wood or metal for burial or cremation. This coffin must be of sufficiently solid construction to withstand load stresses. The preparation area and any place which is contaminated or could possibly be contaminated with body fluids should also be disinfected with sodium hypochlorite. The family of the patient would have been advised to inform the District Health Officer immediately of the death and the nature of the disease. Subsequent disinfection of the body and clothing should be supervised by the Health Inspector/Nurse.

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Differently antibiotics for sinus infection safe while breastfeeding augmentin 375 mg otc, patients with hyperthyroidism due to finished antibiotics for uti still have symptoms order 625mg augmentin mastercard thyroid autonomy usually become hypothyroid several years after radioiodine treatment or never antibiotic walking pneumonia purchase cheap augmentin. In iodine-induced hyperthyroidism antibiotics sinus infection discount 375 mg augmentin with mastercard, especially in amiodarone-induced disease, the normal thyroid function is established not earlier than several months after the beginning of treatment. Afterwards, preventive treatment with radioiodine is a good option for these patients. In conclusion, when the correct cause of hyperthyroidism is established and a proper treatment is implemented, the patients with hyperthyroidism have a good prognosis and mostly a good quality of life. Positron emission tomography reveals correlations between brain metabolism and mood changes in hyperthyroidism. Subclinical thyroid dysfunction and mortality: an estimate of relative and absolute excess all-cause mortality based on time-to-event data from cohort studies. The most simple and I think most accurate is that hypothyroidism is thyroid hormone deficiency. However, we must always keep in mind that hypothyroidism is a condition in tissues, and tissues are able to adapt to different concentrations of thyroid hormones. It occurs in close to 10% of women and 6% of men over 65 years in regions with appropriate iodine intake. The most frequent cause of acquired hypothyroidism is autoimmune (Hashimoto) thyroiditis. The body recognizes the thyroid antigens as foreign, and a chronic immune reaction ensues, resulting in lymphocytic infiltration of the gland and progressive destruction of functional thyroid tissue. Destruction of thyroid gland can result from postpartum thyroiditis, a condition that affects about 5% of all women within a year after giving birth. The course of the disease could be different, but of those women who experience hypothyroidism associated with postpartum thyroiditis, one in five will develop permanent hypothyroidism requiring life-long treatment. Hypothyroidism Inflammatory conditions or viral syndromes may be associated with transient hyperthyroidism followed by transient hypothyroidism (subacute thyroiditis de Quervain). In some patients, subacute thyroiditis could provoke autoimmune thyroiditis and permanent hypothyroidism could develop. Use of radioactive iodine for treatment of Graves? disease generally results in permanent hypothyroidism within 1 year after therapy. The frequency is much lower in patients with toxic nodular goiters and those with autonomously functioning thyroid nodules. External neck irradiation (for head and neck neoplasm, breast cancer, or Hodgkin disease) may result in hypothyroidism. The incidence of congenital hypothyroidism is one in 3 to 4 000 babies and is related to iodine intake. If untreated, congenital hypothyroidism can lead to mental retardation and growth failure. One of them being a completely "normal" thyroid gland that is not making enough hormones because of a problem in the pituitary gland. The consequence is impaired hypothalamo pituitary axis with the influence on other endocrine glands. Up to 80% of the T4 is converted to T3 by peripheral organs such as the liver, kidney and spleen by 5? deiodination. Thyroid hormones stimulate diverse metabolic activities most tissues, leading to an increase in basal metabolic rate. They influence lipid and carbohydrate metabolism and are clearly necessary for normal growth in children. We have to differentiate between the onsets of light hypothyroidism and fully expressed clinical picture. Many elderly patients with hypothyroidism present with nonspecific geriatric syndromes confusion, anorexia, weight loss, falling, incontinence, and decreased mobility. You may have one of these symptoms as your main complaint, while another will not have that problem at all and will be suffering from an entirely different symptom. Occasionally, some patients with hypothyroidism have no symptoms at all, or they are just so subtle that they go unnoticed. As it was stated before, the main cause of hypothyroidism nowadays is Hashimoto thyroiditis. The typical course of this disease is long latent periods interrupted with short active periods. Clinical picture develops slowly and some times, it is very difficult to 31 Hojker S. Consequently, the diagnosis of hypothyroidism is based on clinical suspicion and confirmed by laboratory testing. Although secondary hypothyroidism is uncommon, its causes often affect other endocrine organs controlled by the hypothalamic-pituitary axis. In a woman with hypothyroidism, indications of secondary hypothyroidism are a history of amenorrhea rather than menorrhagia and some suggestive differences on physical examination. Secondary hypothyroidism is characterized by skin and hair that are dry but not very coarse, skin depigmentation, only minimal macroglossia and atrophic breasts. Rarely, complications can result in severe life-threatening depression, heart failure, or coma. Depression and slowed mental functioning may occur early in hypothyroidism especially in elderly and may become more severe over time. Delayed puberty, anovulation, menstrual irregularities, and infertility are common. Babies born to women with untreated thyroid disease have a higher risk of birth defects than do babies born to healthy mothers. Paresthesias of the hands and feet are common, often due to carpal-tarsal tunnel syndrome caused by deposition of proteinaceous ground substance in the ligaments around the wrist and ankle. In patients with fully expressed clinical picture of hypothyroidism, the facial expression is dull; the voice is hoarse and speech is slow; facial puffiness and periorbital swelling occur due to infiltration with the mucopolysaccharides hyaluronic acid. Rarely, untreated may lead to myxedema coma, an extreme form of hypothyroidism in which the body slows to the point that it becomes life threatening. Myxedema coma this rare, life-threatening condition is the result of undiagnosed hypothyroidism. Its symptoms include intense cold intolerance and drowsiness followed by profound lethargy and unconsciousness. A myxedema coma may be triggered by sedatives, infection or other stress on your body. Many patients with primary hypothyroidism have normal circulating levels of fT3, resulting in preferential synthesis and secretion of the biologically active hormone fT3. Kellman believes that this test is the "best way to detect subtle thyroid problems. If we do not find a disease capable to cause a hypothyroidism, than we should reconsider our decision and probably repeat the tests. In every patient with suspicious symptoms or history of hypothyroidism, the autoimmune thyroid disease should be excluded. Ultrasound examination of thyroid gland is a part of basic examination in Outpatient department for thyroid diseases. In this case, the typical hypoechogenic ultrasound pattern confirms the presence of autoimmune thyroid disease. We can conclude that before we are discussing therapy and prognosis we must make a decision about diagnosis of the disease and degree of thyroid failure. Very rarely for patients with decreased conversion of fT4 to fT3 a combination of l thyroxine and triiodothyronine is indicated. Usually we start with lower dose (50 ?g/daily) and in a month, which is usually about 100 ?g/daily. In patients with cardiac involvement or with very low thyroid hormone concentrations starting dose is lower and time used to achieve the maintenance dose is much longer. These patients are also more likely to have hypercholesterolemia and atherosclerosis. In this group of patients, l-thyroxine therapy is also indicated in pregnant women and in women who plan to become pregnant to avoid deleterious effects of hypothyroidism on the pregnancy and foetal development. However, if the condition is diagnosed within the first few months of life, the chances of normal development are excellent. Patients should be monitored for symptoms and signs of overtreatment, which include tachycardia, palpitations, nervousness, tiredness, headache, increased excitability, sleeplessness, tremors, and possible angina.

The cell secretes a variety of products that influence the function of other cells antimicrobial insulation purchase augmentin with a mastercard. Marginating pool the population of neutrophils that are attached to antibiotics for acne skin discount generic augmentin uk or marginated along the vessel walls and not actively circulating virus neutralization test discount augmentin 375mg mastercard. This parameter will correlate with the extent of chromasia exhibited by the stained cells and is calculated from the hemoglobin and hematocrit infection high blood pressure purchase augmentin with paypal. This parameter is useful when evaluating erythrocyte morphology on a stained blood smear. Megakaryocyte A large cell found within the bone marrow characterized by the presence of large or multiple nuclei and abundant cytoplasm. Megaloblastic Asynchronous maturation of any nucleated cell type characterized by delayed nuclear development in comparison to the cytoplasmic development. The abnormal cells are large and are characteristically found in pernicious anemia or other megaloblastic anemia. Microenvironment A unique environment in the bone marrow where orderly proliferation and differentiation of precursor cells take place. Mixed lineage acute An acute leukemia that has both myeloid and leukemia lymphoid populations present or blasts that possess myeloid and lymphoid markers on the same cell. The monoblast has nonspecific esterase activity that is inhibited by sodium fluoride. Monoclonal An alteration in immunoglobulin production that gammopathies is characterized by an increase in one specific class of immunoglobulin. Monocyte-macrophage A collection of monocytes and macrophages, system found both intravascularly and extravascularly. Morulae Basophilic, irregularly shaped granular, cytoplasmic inclusions found in leukocytes in an infectious disease called ehrlichiosis. Mosaic Occurs in the embryo shortly after fertilization, resulting in congenital aberrations in some cells and some normal cells. The cell is associated with chronic plasmocyte hyperplasia, parasitic infection, and malignant tumors. Multiple myeloma Plasma cell malignancy characterized by increased plasma proteins. In instances where large sequences of nucleotides are missing, the alteration is referred to as a deletion. Myelofibrosis with A myeloproliferative disorder characterized by myeloid metaplasia excessive proliferation of all cell lines as well as progressive bone marrow fibrosis and blood cell production at sites other than the bone marrow, such as the liver and spleen. Myeloid-to-erythroid ratioThe ratio of granulocytes and their precursors to (M:E ratio) nucleated erythroid precursors derived from performing a differential count on bone marrow nucleated hematopoietic cells. Myeloperoxidase An enzyme present in the primary granules of myeloid cells including neutrophils, eosinophils, and monocytes. Myelophthisis Replacement of normal hematopoietic tissue in bone marrow by fibrosis, leukemia, or metastatic cancer cells. National Committee for National agency that establishes laboratory Clinical Laboratory standards. Neutrophil A mature white blood cell with a segmented nucleus and granular cytoplasm. Seen in bacterial infections, inflammation, metabolic intoxication, drug intoxication, and tissue necrosis. Normal pooled plasma Platelet-poor plasma collected from at least 20 individuals for coagulation testing. The plasma is pooled and used in mixing studies to differentiate a circulating inhibitor from a factor deficiency. Nuclear-cytoplasmic A condition in which the cellular nucleus matures asynchrony slower than the cytoplasm, suggesting a disturbance in coordination. As a result, the nucleus takes on the appearance of a nucleus associated with a younger cell than its cytoplasmic development indicates. This is usually estimated as the ratio of the diameter of the nucleus to the diameter of the cytoplasm. In immature hematopoietic cells the N:C ratio is usually greater than in more mature cells. It is not present in cells that are not synthesizing proteins or that are not in mitosis or meiosis. Nucleus (pl: nuclei) the characteristic structure in the eukaryocytic cell that contains chromosomes and nucleoli. In young, immature hematopoietic cells, the nuclear material is open and dispersed in a lacy pattern. As the cell becomes mature, the nuclear material condenses and appears structureless. Most oncogenes are altered forms of normal genes that function to regulate cell growth and differentiation. Optimal counting area Area of the blood smear where erythrocytes are just touching but not overlapping; used for morphologic evaluation and identification of cells. Vitamin K is required for the synthesis of functional prothrombin group coagulation factors. Orthochromatic A nucleated precursor of the erythrocyte that normoblast develops from the polychromatophilic normoblast. On romanowsky stain, visible near the periphery of the cell and often occur in clusters. Pelger-Huet anomaly An inherited benign condition characterized by the presence of functionally normal neutrophils with a bilobed or round nucleus. Peripheral membrane Protein that is attached to the cell membrane by protein ionic or hydrogen bonds but is outside the lipid framework of the membrane. Petechiae Small, pinhead-sized purple spots caused by blood escaping from capillaries into intact skin. Phagocytosis Cellular process of cells engulfing and destroying a foreign particle through active cell membrane invagination. Phagolysosome A digestive vacuole (secondary lysosome) formed by the fusion of lysosomes and a phagosome. Phase microscopy A type of light microscopy in which an annular diaphragm is placed below or in the substage condenser, and a phase shifting element is placed in the rear focal plane of the objective. This causes alterations in the phases of light rays and increases the contrast between the cell and its surroundings. Plasma cell A transformed, fully differentiated B lymphocyte normally found in the bone marrow and medullary cords of lymph nodes. May be seen in the circulation in certain infections and disorders associated with increased serum? The cell is characterized by the presence of an eccentric nucleus containing condensed, deeply staining chromatin and deep basophilic cytoplasm. The large Golgi apparatus next to the nucleus does not stain, leaving an obvious clear paranuclear area. Plasmacytosis the presence of plasma cells in the peripheral blood or an excess of plasma cells in the bone marrow. Large amounts of plasminogen are absorbed with the fibrin mass during clot formation. Platelets play an important role in primary hemostasis adhering to the ruptured blood vessel wall and aggregating to form a platelet plug over the injured area. Platelet aggregation Platelet-to-platelet interaction that results in a clumped mass; may occur in vitro or in vivo. Platelet procoagulant the property of platelets that enables activated activity coagulation factors and cofactors to adhere to the platelet surface during the formation of fibrin. Has the potential to self-renew, proliferate, and differentiate into erythrocytic, myelocytic, monocytic, lymphocytic, and megakaryocytic blood cell lineages. Poikilocytosis A term used to describe the presence of variations in the shape of erythrocytes. If stained with new methylene blue, these cells would show reticulum and would be identified as reticulocytes. Polyclonal gammopathy An alteration in immunoglobulin production that is characterized by an increase in immunoglobulins of more than one class. Polymorphic variants Variant morphology of a portion of a chromosome that has no clinical consequence. Substituents occupy each of the eight peripheral positions on the four pyrrole rings.

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  • A tube will be placed through the nose into the stomach (nasogastric tube) during the surgery.
  • How long it took you to empty your bladder
  • Avoiding eye irritants
  • Death of liver tissues
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Renal Association Clinical Practice Guideline Anaemia of Chronic Kidney Disease June 2017 4 Articles were considered of particular relevance if they were describing:? Where evidence was available from the above sources infection questionnaires order augmentin canada, recommendations were based on these publications antibiotic list drugs generic 375 mg augmentin with visa. It is associated with left ventricular dysfunction and heart failure antibiotic resistance usda buy discount augmentin 375mg online, in addition to infection zombie movies order cheap augmentin line a reduction in exercise capacity and quality of life. Grading evidence and recommendations for clinical practice guidelines in nephrology. Revised European best practice Guidelines for the management of anaemia in patients with chronic renal failure. Renal Association Clinical Practice Guideline Anaemia of Chronic Kidney Disease June 2017 5 2. Based on the initial assessment we recommend in selected cases, the following tests may be useful to diagnose the cause of anaemia (1B):? These thresholds for intervention should achieve a population distribution centred on a mean of 110 g/L with a range of 100-120 g/L. Hyporesponsive patients who are iron replete should be screened clinically and by investigations for other common causes of anaemia. Alternatively data from clinical trials have shown that the rate of Hb decline in these patients is (1, 2) gradual one. Anaemia is defined as having a Hb value below the established cut off defined by the World Health (4) Organisation. Anaemia is defined as a haemoglobin concentration less than the 5th percentile for age. In addition to gender, age and pregnancy other factors influence Hb level including smoking, altitude, race and genetic disorders (thalassemia and sickle cell disease). The degree of renal impairment affects the likelihood of any patient developing anaemia. The current definition for anaemia applies to adult patients older than 18 years, of all races and ethnic groups, and living at relatively (7) low altitude (<1,000 m or 3,000 ft. With increasing altitude, endogenous erythropoietin production is increased; as a result, Hb concentration can be expected to increase by about 6 g/L in women and 9 g/L in men (8) for each 1,000m of altitude above sea level. Kidney Disease: Improving Global Outcomes guidelines on anaemia management in chronic kidney disease: a European Renal Best Practice position statement. Iron deficiency anaemia, assessment, prevention and control: a guide for programme managers. Haemoglobin concentration of pastoral nomads permanently resident at 4,850 5,450 meters in Tibet. Renal Association Clinical Practice Guideline Anaemia of Chronic Kidney Disease June 2017 13 Guideline 1. In these patients the prevalence of gender specific anaemia (<120 g/L men: < 110 g/L women) was 12%. Identifying patients with chronic kidney disease from general practice computer records. Prevalence of anaemia in persons 65 years and older in the United States: Evidence for a high rate of unexplained anaemia. Diabetes mellitus increases the severity of anaemia in non-dialyzed patients with renal failure. The burden of anaemia in type 2 diabetes and the role of nephropathy: A cross-sectional audit. Higher prevalence of anaemia with diabetes mellitus in moderate kidney insufficiency: the Kidney Early Evaluation Program. Renal Association Clinical Practice Guideline Anaemia of Chronic Kidney Disease June 2017 14 References 1. The rate and control of baseline red cell production in haematologically stable patients with uraemia. Erythropoietin response to blood loss in haemodialysis patients in blunted but preserved. Renal Association Clinical Practice Guideline Anaemia of Chronic Kidney Disease June 2017 15 the recommended laboratory evaluation aims at assessing:? Anaemia due to causes other than erythropoietin deficiency should be suspected when:? The severity of the anaemia is disproportionate to the deficit in renal function,? There is evidence of bone marrow disorder as manifest by leucopoenia and/or thrombocytopenia. Haemoglobin concentrations are routinely measured in dialysis patients before dialysis. This potentially leads to lower haematocrit values as a result of dilution from fluid overload prior to ultrafiltration and an underestimate to actual haemoglobin value. Interdialytic weight gain contributes to a decrease in Hb level, whereas intradialytic ultrafiltration leads to an increase in Hb level. Thus, a pre-dialysis sample underestimates the euvolaemic Hb level, whereas a post dialysis sample over-estimates the euvolaemic Hb. Indeed changes on haematocrit can vary from the start to the end of dialysis by up to 6% depending of the volume of ultrafiltration. There was a strong linear inverse correlation between percentage of change in Hb and haematocrit (Hct) values and percentage of change in body weight. In unit based haemodialysis patients receiving thrice weekly dialysis, Hb monitoring performed prior to a mid-week haemodialysis session would minimise Hb variability due to the longer inter-dialytic interval between the last treatment of one week and the first of the next. Pre dialysis versus post dialysis haematocrit evaluation during erythropoietin therapy. Influence of the cyclic variation of hydration status on haemoglobin levels in haemodialysis patients. Renal Association Clinical Practice Guideline Anaemia of Chronic Kidney Disease June 2017 16? Macrocytosis with leucopoenia or thrombocytopenia could be due to several factors such as alcohol intake, nutritional deficit (vitamin B12 or folate deficiency), or myelodysplasia. Although it has a significant inter-patient variability, this test may be useful as a semi-quantitative marker of erythropoietic activity. Because a fresh sample is needed, this measure may not be practical in routine clinical practice. High serum ferritin, in addition to expressing the adequacy of iron stores, could be due to inflammatory conditions. The efficacy of iron dextran for the treatment of iron deficiency in haemodialysis patients. Diagnosis of iron deficiency anaemia in renal failure patients during the post-erythropoietin era. Iron deficiency anaemia in the elderly: Prevalence and endoscopic evaluation of the gastrointestinal tract in outpatients. Iron deficiency and gastrointestinal malignancy: A population based cohort study. Prospective evaluation of a clinical guideline for the diagnosis and management of iron deficiency anaemia. Increasing the Hb in anaemic patients places the greatest demand for iron in the erythropoietic tissues. Once the target Hb has been reached and Hb stabilised, the iron requirements will be dependent on ongoing iron losses. The serum ferritin, transferrin saturation and percentage of hypochromic red blood cells were all less accurate. Patients were classified as having iron deficiency if haematocrit value increased by 5% or if their erythropoietin dose decreased by 10% by 2 months. Receiver operator curves demonstrated that none of the iron indices had a high level of utility (both sensitivity and specificity > 80%). Since a fresh blood sample is needed, this test may be difficult to use routinely in clinical practice. Subcutaneous erythropoietin results in lower dose and equivalent hematocrit levels among adult haemodialysis patients: Results from the 1998 End-Stage Renal Disease Core Indicators Project. Renal Association Clinical Practice Guideline Anaemia of Chronic Kidney Disease June 2017 20 9. Optimization of epoetin therapy with intravenous iron therapy in haemodialysis patients.