A client is to receive epoetin (Epogen) injections. What laboratory value should the nurse assess before giving the injection?
A. Hematocrit
B. Partial thromboplastin time
C. Hemoglobin concentration
D. Prothrombin time
Correct Answer: A. Hematocrit
Epogen is a recombinant DNA form of erythropoietin, which stimulates the production of RBCs and therefore causes the hematocrit to rise. The elevation in hematocrit causes an elevation in blood pressure; therefore, the blood pressure is a vital sign that should be checked. Although epoetin alfa does not affect blood pressure directly, it may raise blood pressure in the early phase after administration when the hematocrit is increasing acutely. So, it should be used very carefully in patients with uncontrolled hypertension. Additionally, patients may require dosage adjustments of antihypertensive therapy after initiation of this medication.
Option B: Due to a sudden increase in hematocrit, blood viscosity, and peripheral vascular resistance, particularly dialysis patients, may require to adjust anticoagulation. Serious thromboembolic events like increased clot formation in atrioventricular (AV) shunts, migratory thrombophlebitis, microvascular thrombosis, thrombosis of major vessels like retinal, temporal, pulmonary, and renal vessels increases.
Option C: It increases the risk of serious cardiovascular events, vascular access thrombosis, stroke, myocardial infarction, venous thromboembolism in clinical studies when target Hb levels reach more than 11 g/dL or a rapid rise in hemoglobin over 1 g/dL over two weeks (U.S. Boxed Warning).
Option D: PT is not monitored for this drug. Serum ferritin and transferrin saturation require measurement before initiation of epoetin alfa. If the serum ferritin level is less than 100 ng/mL and/or serum transferrin saturation level is less than 20%, then supplemental iron should be started before the initiation of epoetin alfa treatment.
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