What are the new Medicare guidelines for the administration of an epoetin alfa injection (Procrit) or a darbepoetin alfa injection (Aranesp)? I have heard that the new hemoglobin (Hb) guidelines are between 10 and 12 g/dL.

The new Medicare guidelines for Procrit or Aranesp apply to treatment for chronic renal failure and chemotherapy-induced anemia. Both are based on the Hb for dosing. The guidelines state that chronic renal failure treatment with an ESA (erythropoietin-stimulating agent) should be initiated at a Hb level of less than 10 g/dL. The goal of treatment is resolution of anemia to a Hb level higher than 12 g/dL. Chemotherapy-induced anemia is defined as a Hb level of less than 10 g/dL. The goal in this setting also is resolution of anemia to a Hb level of at least 10 g/dL to avoid blood transfusions. However, after the dose has been increased once by 25% without response, the ESA should be discontinued in patients with chemotherapy-induced anemia. — Jiajoyce R. Conway, DNP, FNP-BC, NP-C