Background The medical care of Jehovah’s Witness patients, because they refuse blood transfusion, becomes problematic in cases of severe life-threatening anaemia. Purpose To describe the case of a patient with severe anaemia who received erythropoietin (EPO) treatment as the result of a literature review. Materials and Methods A 77-year old woman was sent to the emergency department with thoracoepigastric pain, blood clots and vomiting for a week. Cardiac examination revealed a coronary syndrome caused by gastrointestinally-induced anaemia at 5.6 g/dl (haematocrit = 18.9%). On day 3 the haemoglobin fell to 4 g/dl (haematocrit = 14.4%) upon which a treatment with EPO beta at 30,000 IU per week (380 IU/kg/week) associated with high intravenous iron supplementation (300 mg/48 hours) was instituted. After 16 days of treatment haemoglobin (8.9 g/dl) and haematocrit (31.6%) had doubled and clinical improvement was observed. The patient was discharged on day 22 of treatment with a total of 4 EPO injections (haemoglobin = 9.6 g/dl). Results Currently in emergency there is no alternative to transfusion and a higher mortality is linked to a low haemoglobin level. In a multicentre study with 148 patients, Georgopoulos et al, showed the efficacy of EPO, used off-label, administered once weekly, to reduce transfusions. Thirteen recent publications reported experiences with the intravenous or subcutaneous administration of EPO in anaemia treatment. The optimal dose of EPO remains unclear: dosage ranges from 200 μg/week darbepoetin alfa (Gutierrez et al), to 130 IU/kg of EPO three times weekly (Walton et al), to 600 Iu/kg/day for 2 days to 300 IU/kg/day (Cothren et al). After starting treatment the haemoglobin level doubled in 19 days (in an average of 4 days–30 days). Conclusions Our weekly EPO protocol is in the lower targets found in the literature but it appears as effective as other protocols. Significant variability without a major difference in efficacy appears when EPO is used for Jehovah’s Witness patients, but EPO may provide an alternative treatment in life-threatening anaemia, when blood transfusions are not accepted. No conflict of interest.

En France, les médicaments prescrits pendant une hospitalisation sont dispensés par la pharmacie à usage intérieur. Or la pharmacie n’a pas en stock tous les médicaments disponibles sur le marché et doit donc proposer des équivalences thérapeutiques. De ce fait, des patients hospitalisés apportent souvent leurs traitements et les utilisent parfois en dehors du cadre légal. L’objectif de ce travail est d’étudier la fréquence et les circonstances d’utilisation de ces médicaments dans sept services de médecine et quatre de chirurgie. Un questionnaire de cinq items a été élaboré par la pharmacie. Pendant une semaine, l’équipe pharmaceutique a interrogé chaque patient admis dans ces services. Cent vingt-deux patients ont ainsi été questionnés. Avant l’hospitalisation, 98 (80 %) avaient un traitement à domicile, 50 (41 %) l’avaient apporté, 11 (9 %) n’avaient pas mis au courant le personnel médical. Cent soixante-deux spécialités ont été retrouvées, dont 28 % n’étaient pas prescrites. Quatre-vingt treize pour cent sont retrouvées dans la chambre (55 % ne sont pas utilisées, 36 % sont gérées par le patient, 9 % par le personnel médical). Le reste des médicaments est gardé hors de la chambre. Cette étude montre que des médicaments sont effectivement présents dans les chambres des patients. La pharmacie a élaboré une procédure et un guide local de prescription pour mieux encadrer ces pratiques, puis les a diffusés auprès des services. In France, inpatients receive prescribed drugs necessarily from hospital pharmacy. Since all medications are not available at the hospital pharmacy, drugs are substituted. Therefore, some patients bring their own outpatient medications despite the regulation. The objective is to study the frequency and circumstances of use of outpatient medications in seven medicine wards and four surgery wards. A questionnaire with five items was developed by pharmacy. During one week, pharmacy team interviewed each inpatient present the day of study. During study, 122 patients were interviewed. Before their hospitalizations, 98 (80%) had medications prescribed by their general practitioners. Fifty (41%) brought their medications with them, 11 (9%) used them without informing medical staff. One hundred and sixty-two medications were found and 28% were not prescribed. Ninety-three percent were found in patient's room (55% were not used, 36% were used by patients without intervention of medical staff, 9% with intervention of medical staff). Seven percent were found out of room. This study shows that outpatient medications are used during hospitalization. Pharmacy has developed protocols and local pocket guidelines in order to better care for outpatient medication and inform ward to explain new rules.

BACKGROUND:The epidemiology of patients with lung cancer in a Seine-Saint-Denis hospital are reported, as well as causes of diagnostic and therapeutic delays in their management.MATERIAL AND METHODS:Retrospective analysis of cases diagnosed from January 1, 1997 to December 31, 2003.RESULTS:Of 355 cases, 15.8% were women; the average age was 62 +/- 11. Mean smoking history was 50 +/- 24 pack years. Women were more likely to be non-smokers than men (16% and 1% respectively, p < 0.01) and were more likely to present at a young age (under the age of 50: 26.8% and 13.7% respectively, p < 0.05). Among women, adenocarcinoma was more frequent (41% vs. 25%, p < 0.05), and often presented with stage IV disease (74%). Squamous cell carcinoma occurred more frequently with increasing age (18.7% vs. 32.2% before and after the age of 60, p < 0.01). The median pre hospital, diagnostic and treatment delays were respectively 30, 10 and 9 days, the global delay from first symptom to treatment was 62 days. Surgery increased therapeutic delay by 20 days.CONCLUSION:Our results are complementary to those found in KBP-2000-CPHG study. Young women are diagnosed at a late stage. Influence of delays on prognosis is not proved and require others studies.

The aim of this study was to explore the frequency and type of adverse drug reactions between January and June 2001 in hospitalised patients. A prospective study was conducted in two pneumology departments of public hospitals in the Seine-Saint-Denis area. Adverse drug reactions were collected by hospital pharmacists after spontaneous notification by nurses and physicians, except for deliberate drug overdose. The drugs implicated, causality and the severity of each adverse drug reaction were analysed. The mean age of patients was 69 +/- 15 years (63% male and 37% female). The total sample comprised 1598 patients. During the period of the study, 190 patients experienced at least one adverse drug reaction. This amounts to a prevalence of 12% (95% confidence interval [95% CI: 7.4-16.6%). The percentage of severe adverse effects was 28.4% (95% CI: 25.1-31.6%) and adverse reactions were rated avoidable in 35.8% of cases (95% CI: 32.3-39.3%). Antibiotics (23%), corticosteroids (15%), analgesics (13%) and anticoagulants (9%) were the drugs most frequently implicated in adverse effects. Preventable adverse drug events were more serious than non-preventable adverse events (p = 0.001). With regard to the level of severity, antibiotics, corticosteroids and bronchodilators were associated with a low severity level, whereas anticoagulants and antineoplastics were associated with a high severity level.