RETACRIT (EPOETIN ALFA-EPBX)		version 2/27/2025		

Appointment Requests 	

	
	Interval	Defer Until	Duration	
	☑	Referral to IV Infusion Room				
		Status: Future, Expected: S, Expires: S+365, Clinic Performed
	Urgency of Scheduling: Routine		

Provider Communication 	

	
	Interval	Defer Until	Duration	
	☐	Provider communication	Once	S	1 treatment	
		Coverage Determination Considerations: Hemoglobin must be LESS than 10 g/dL (hematocrit LESS than 30%) and obtained within 7 days.
	For 1st dose only.		

Labs 	

	
	Interval	Defer Until	Duration	
	☐	Hemoglobin & hematocrit	Every visit	S	Until discont'd	
		STAT, Normal, Clinic Collect		
	☐	CBC with platelet and differential	Every visit	S	Until discont'd	
		STAT, Normal, Clinic Collect		
	☐	Iron level	Once	S	1 treatment	
		STAT, Normal, Clinic Collect		
	☐	Total iron binding capacity	Once	S	1 treatment	
		STAT, Normal, Clinic Collect		
	☐	Ferritin level	Once	S	1 treatment	
		STAT, Normal, Clinic Collect		
	☐	Transferrin level	Once	S	1 treatment	
		STAT, Normal, Clinic Collect		

Nursing Orders 	

	
	Interval	Defer Until	Duration	
	☐	Nursing communication	Every visit	S	Until discont'd	
		Ensure hemoglobin / hematocrit results have been obtained before each dose. If not, please obtain.		

Medications 	

	
	Interval	Defer Until	Duration	
	☐	epoetin alfa-epbx (RETACRIT) Non-Oncology injection				
		subcutaneous, once, Starting when released
	If the Hemoglobin is greater than or equal to 11 mg/dL, contact the physician before administering. The nurse may administer this via IV injection or subcutaneous injection. The preferred route is IV injection. If IV access is not available, the nurse can change this order to a subcutaneous injection.