9: Nutrition and blood
Approved: 4 Oct 2017. Last amended: 5 Jan 2024.
9.1 Anaemias and some other blood disorders
9.1.1 Iron deficiency anaemia
9.1.1.1 Oral iron
Recommended
Ferrous fumarate 322mg tablets
Alternative
Ferrous sulfate 200mg tablets
Specific Indication
Ferrous fumarate liquid 140mg/5ml
Patients unable to swallow iron tablets
Sodium feredetate liquid
Neonate / Paediatric use
Feraccru® (ferric maltol)
Gastroenterology only, as per Local Guideline
9.1.1.2 Oral iron with folic acid
Specific Indication
Ferrous fumarate (305mg) with folic acid (350mcg) Galfer FA®
9.1.1.3 Parenteral iron
Specific Indication
Cosmofer® (iron dextran)
Cosmofer® guideline
Sample Cosmofer® prescription chart
Diafer® (ferric derisomaltose)
Renal dialysis patients only
Ferinject® (ferric carboxymaltose)
Sample Ferinject® prescription chart
Monofer® (ferric derisomaltose)
Sample Monofer® prescription chart
9.1.2 Megaloblastic anaemia
9.1.2.1 Folic Acid
Recommended
Folic acid tablets
Specific Indication
Folic acid liquid
Patients unable to swallow tablets
9.1.2.2 Vitamin B12
Vitamin B12 Deficiency Guideline
Vitamin B12 Deficiency treatment algorithm
Recommended
Cyanocobalamin 100mcg, 1mg tablets
Specific Indication
Hydroxocobalamin 1mg i.m. injection
Where oral cyanocobalamin is unsuitable (as per local guideline)
9.1.3 Hypoplastic, haemolytic and renal anaemias
9.1.3.1 Erythropoeisis Stimulating Agents
Recommended
Aranesp® (darbepoetin)
- anaemia in people with cancer having chemotherapy, as per NICE TA323
- anaemia associated with chronic kidney disease, as per NICE NG8
Mircera® (methoxy polyethylene glycol-epoetin beta)
- anaemia associated with chronic kidney disease, as per NICE NG8
Specific Indication
Other erythropoeisis stimulating agents
- as per NICE TA323 / NICE NG8
Roxadustat
- symptomatic anaemia in chronic kidney disease, as per NICE TA807
9.1.3.2 Iron Chelators
Deferasirox
Deferiprone
Desferrioxamine mesilate
Dexrazoxane
9.1.3.3 Atypical haemolytic uraemic syndrome and paroxysmal nocturnal haemoglobinuria
Eculizumab
As per NICE HST1
Pegcetacoplan
As per NICE TA778
Ravulizumab
- Paroxysmal nocturnal haemoglobinuria: NICE TA698
- Atypical haemolytic uraemic syndrome: NICE TA710
9.1.3.4 Sickle cell disease
Specific Indication
Crizanlizumab
Prevention of sickle cell crises in sickle cell disease, as per NICE TA743
9.1.4 Drugs Used in Platelet Disorders
Anagrelide
Essential thrombocythaemia in patients at risk of thrombo-haemorrhagic events who have not responded adequately to other drugs or who cannot tolerate other drugs
Avatrombopag
- For treating thrombocytopenia in people with chronic liver disease needing a planned invasive procedure NICE TA626
- Primary chronic immune thrombocytopenia NICE TA853
Caplacizumab
Acute acquired thrombotic thrombocytopenic purpura, as per NICE TA667
Eltrombopag
Chronic immune (idiopathic) thrombocytopenic purpura, as per NICE TA293
Fostamatinib
Refractory chronic immune thrombocytopenia, as per NICE TA835
Lusutrombopag
Thrombocytopenia in people with chronic liver disease needing a planned invasive procedure, as per NICE TA617
Romiplostim
Chronic immune (idiopathic) thrombocytopenic purpura, as per NICE TA221
9.1.5 Drugs used in neutropenia
Recommended
Filgrastim
Specific Indication
Lenograstim
Pegfilgrastim
9.1.6 Drugs used to mobilise stem cells
Plerixafor
9.2 Fluid and electrolyte imbalances
9.2.1 Fluids
9.2.1.1 Oral Rehydration Therapy
Recommended
Oral Rehydration Therapy (ORT)
Specific Indication
St Mark’s Formula Electrolyte Drink
Sodium chloride (table salt), glucose powder, sodium bicarbonate powder and water.
9.2.1.2 Intravenous fluids
GHNHSFT Treatment Guideline – Intravenous Fluid Management in Adults
GHNHSFT Treatment Guideline – Intravenous Fluid Management in Children
9.2.2 Bicarbonate
Recommended
Sodium bicarbonate 500mg capsules
Sodium bicarbonate injection / infusion
Specific Indication
Sodium bicarbonate 1mmol/ml oral solution
Paediatrics
9.2.3 Calcium
9.2.3.1 Hypocalcaemia
GHNHSFT Treatment Guideline – Hypocalcaemia
Recommended
Calci-D®
(Calcium carbonate 2.5g [equiv. to calcium 1g] / colecalciferol 1,000iu) chewable tablets
Calcium gluconate 10% injection
Specific Indication
Adcal® 1500mg (calcium carbonate) chewable tablets
Where combined calcium and vitamin D is usuitable
Cacit® 500mg (calcium carbonate) effervescent tablets
Patients unable to tolerate the chewable tablets
9.2.3.2 Hypercalcaemia
Cinacalcet
- Secondary hyperparathyroidism in patients with end-stage renal disease on maintenance dialysis therapy, as per NICE TA117
- Primary hyperparathyroidism if surgery has been unsuccessful or is unsuitable, as per NICE NG132
Etelcalcetide
- Secondary hyperparathyroidism in patients with end-stage renal disease on maintenance dialysis therapy, where cinacalcet is unsuitable, as per NICE TA448
9.2.4 Magnesium
GHNHSFT Treatment Guideline – Hypomagnesaemia
Recommended
Magnesium Hydroxide mixture BP 8% (7mmol/5ml)
Magnesium sulphate 50% injection
Alternative
Magnesium aspartate (Magnaspartate®) sachets
Magnesium citrate tablets
4mmol (97mg)
9.2.5 Phosphate
9.2.5.1 Hypophosphataemia
UKMi Treatment Guideline - Hypophosphataemia
Recommended
Phosphate Sandoz® tablets
Each tablet contains phosphate 16.1mmol, sodium 20.4mmol, potassium 3.1mmol)
Phosphates Polyfusor®
Each 500ml Polyfusor® contains phosphate 50mmol, sodium 81mmol, potassium 9.5mmol)
9.2.5.2 Hyperphosphataemia
Recommended
Renacet®
(Calcium acetate) tablets. Phosphate binder in renal impairment
Alternative
Adcal® 1500mg (calcium carbonate) chewable tablets
Adcal® D3 (calcium carbonate 1500mg / colecalciferol 400units) chewable tablets
Specific Indication
Sevelamer carbonate 800mg tablets / 2.4g sachets
Second-line where calcium-based phosphate binders are ineffective/ unsuitable.
Lanthanum
Third-line where calcium-based phosphate binders and sevelamer are ineffective / unsuitable.
9.2.6 Potassium
9.2.6.1 Hypokalaemia
GHNHSFT Treatment Guideline – Hypokalaemia
Recommended
Sando K® effervescent tablets (12mmol K+ per tablet)
Intravenous potassium
Use pre-made infusion bags
Specific Indication
Kay Cee L® liquid (1mmol K+ per ml)
Patients unable to tolerate Sando K
9.2.6.2 Hyperkalaemia
GHNHSFT Treatment Guideline – Hyperkalaemia
Specific Indication
Sodium zirconium cyclosilicate
Hyperkalaemia, as per NICE TA599
Patiromer
Hyperkalaemia, as per NICE TA623
9.2.7 Sodium
9.2.7.1 Hyponatraemia
GHNHSFT Treatment Guideline – Hyponatraemia
Recommended
Slow Sodium® (sodium chloride modified-release) tablets
Each tablet contains 10mmol sodium
Demeclocycline
Intravenous sodium chloride
Specific Indication
Samsca® (tolvaptan)
Consultant Endocrinologist only.
Restricted to patients with symptomatic hyponatraemia (secondary to SIADH) who have failed to respond to fluid restriction and demeclocycline.
9.2.8 Zinc
Recommended
Solvazinc® (zinc sulphate) effervescent tablets
9.3 Metabolic disorders
Asfotase
Paediatric-onset hypophosphatasia, as per NICE HST6
Avalglucosidase alfa
Pompe Disease, as per NICE TA821
Cerliponase alfa
Neuronal ceroid lipofuscinosis type 2, as per NICE HST12
Cipaglucosidase alfa
Late-onset Pompe disease, as per NICE TA912
Eladocagene exuparvovec
Aromatic L-amino acid decarboxylase deficiency, as per NICE HST26
Eliglustat
Type 1 Gaucher disease, as per NICE HST5
Elosulfase alfa
Mucopolysaccharidosis type 4A, as per NICE HST1919
Inotersen
Hereditary transthyretin amyloidosis, as per NICE HST9
Lumasiran
Primary hyperoxaluria type 1, as per NICE HST25
Migalastat
Fabry disease, as per NICE HST4
Patisiran
Hereditary transthyretin amyloidosis, as per NICE HST10
Pegunigalsidase alfa
Fabry disease, as per NICE TA915
Sebelipase alfa
Wolman disease, as per NICE HST30
Velmanase alfa
Alpha-mannosidosis, as per NICE HST29
9.3.1 Acute porphyrias
Givosiran
Acute hepatic porphyria, as per NICE HST16
Haem Arginate (Normasang®)
9.4 Nutrition
9.4.1 Foods for special diets
Sapropterin
- hyperphenylalaninaemia in phenylketonuria, as per NICE TA729
9.4.2 Enteral Nutrition
Secondary Care Enteral Nutrition Formulary - under development
9.5 Vitamin deficiencies
9.5.1 Vitamin A
9.5.2 Vitamin B
Vitamin B12 Deficiency Guideline
Vitamin B12 Deficiency treatment algorithm
9.5.3 Vitamin C
9.5.4 Vitamin D
GHNHSFT Vitamin D Treatment Guideline
9.5.4.1 High Dose Colecalciferol
Recommended
HuxD3®
(colecalciferol 20,000iu) capsules
Specific Indication
Colecalciferol
300,000iu in 1ml injection
9.5.4.2 Low Dose Colecalciferol
Stexerol-D3®
(colecalciferol 1,000iu) tablets
9.5.4.3 Calcium with Vitamin D
Calci-D®
(Calcium carbonate 2.5g [equiv. to calcium 1g] / colecalciferol 1,000iu) chewable tablets