102.3 🩺 內科專科考前版

102.3.0.1 📌 䞀頁重點

  • 22E: alternate-day oral iron; HIF-PHI (roxadustat/vadadustat/daprodustat) for CKD anemia oral; luspatercept (Reblozyl) for MDS-RS + β-thalassemia (TGF-β inhibitor); ferric carboxymaltose hypophosphatemia issue
  • Taiwan: 健保 oral iron + IV iron 條件 (carboxymaltose, sucrose, LMW dextran 條件); 健保 ESA for CKD; 健保 daprodustat / roxadustat 條件 (新, 郚分自費); luspatercept 自費 倚

102.3.0.2 🌟 Pearls (10)

  1. Alternate-day oral iron (Cochrane 2019, NEJM): better absorption + less GI; standard now
  2. Hepcidin assay emerging clinical marker (research) for IDA vs ACD distinction
  3. Ferric carboxymaltose hypophosphatemia: monitor P; can cause osteomalacia in repeated dosing
  4. Liposomal iron (sucrosomial): oral, less GI; for inflammation patients
  5. TREAT trial 2009: ESA in DM-CKD pre-dialysis; Hb target normalization → ↑ stroke + thrombosis
  6. CHOIR trial: similar Hb full normalization harm
  7. HIF-PHI vs ESA: oral convenience, similar outcomes; CV signal in some trials
  8. Luspatercept (Reblozyl): FDA 2019 for MDS-RS; expanded 2023 for previously untreated MDS; β-thal transfusion-dependent
  9. Anemia in HF: IV iron (FAIR-HF, AFFIRM-AHF) improves NYHA + 6MWT
  10. Pregnancy IV iron: ferric carboxymaltose 2nd-3rd trimester for severe IDA

102.3.0.3 📍 Taiwan + 健保

  • 健保 oral ferrous sulfate / fumarate / gluconate
  • 健保 IV iron sucrose (Venofer) — 條件
  • 健保 ferric carboxymaltose (Ferinject) — 條件 (鉮 limit)
  • 健保 low-MW iron dextran — 條件
  • 健保 ESA (epoetin alfa, darbepoetin) for CKD/cancer 條件
  • 健保 daprodustat (Duvroq) + roxadustat (Evrenzo) for CKD anemia 條件
  • 健保 luspatercept (Reblozyl) for MDS-RS + β-thal 條件 (新)
  • 健保 colonoscopy + EGD for IDA workup
  • 健保 tissue transglutaminase for celiac
  • 孞會: TSH (Taiwan Society of Hematology) + Taiwan Society of Nephrology

102.3.0.4 🎓 內專必懂 (10)

  1. MCV-based + retic-based 分類
  2. IDA vs ACD vs combined biochemistry
  3. Adult IDA workup must include colonoscopy
  4. Alternate-day oral iron evidence
  5. IV iron formulation selection + SE
  6. CKD anemia + ESA target + TREAT trial
  7. HIF-PHI oral 22E + cardiovascular safety
  8. Sideroblastic anemia workup + B6 trial
  9. Luspatercept for MDS-RS + β-thal
  10. HF + IV iron (FAIR-HF, AFFIRM-AHF)

⚠ AI 草皿。