Anemia of chronic disease medical therapy: Difference between revisions
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==Overview== | ==Overview== | ||
==Medical Therapy== | ==Medical Therapy== | ||
*The primary goal in the treatment of anemia of chronic disease it to treat the disease itself. | *The primary goal in the treatment of [[anemia]] of chronic disease it to treat the [[disease]] itself. | ||
Supplemental iron: | ==== Supplemental iron: ==== | ||
*Supplemental iron is recommended, as needed, to keep the transferrin saturation of above 20 percent and a serum ferritin level of | *[[Iron|Supplemental iron]] is recommended, as needed, to keep the [[transferrin]] saturation of above 20 percent and a [[serum]] [[ferritin]] level of above100 ng/mL. | ||
==== Intravenous iron: ==== | |||
* | * [[Intravenous therapy|Intravenous]] [[iron]] is more effective than [[Oral|oral supplementaion.]] | ||
*[[Intestinal]] absorption of [[iron]] is greatly reduced due to [[hepcidin]] activity at [[Intestinal|intestinal lining]]. | |||
*[[Hepcidin]]-induced entrapment of [[iron]] can be managed with [[parenteral]] iron infusions. | |||
In | ==== Erythropoietin: ==== | ||
In case of patients who do not respond to [[oral]] or [[parenteral]] iron infusions [[erythropoietin]] should be considered. | |||
*Stable patients can be administered synthetically prepared [[erythropoiesis]]-stimulating agent such as [[erythropoietin]]. | |||
*[[Erythropoietin]] can be given once per week, while [[darbepoetin]] should be administered once every two or three weeks. | |||
*It is important to give [[oral]] [[iron]] supplementation to all the patients receiving [[erythropoietin]] or [[darbepoetin]], in order to maintain a t[[Transferrin|ransferrin]] [[saturation]] more than 20 percent and a [[serum]] [[ferritin]] more than 100 ng/mL. | |||
*If the case is underlying malignancy, | ==== Blood Transfusion: ==== | ||
*If the cause is inflammatory disorder, such as rheumatoid arthritis the management of the disease with a disease-modifying antirheumatic drug (DMARD) improves the anemia significantly. | *In case of severe [[disease]], [[blood transfusion]] is recommended. | ||
*If the root cause of anemia is not found, a detailed search for inflammatory disorders such as inflammatory bowel disease and malignancy should be carried. | |||
*It is recommended to start with age-appropriate health screening. | ==== In majority of cases, treatment of the underlying disorder is more effective: ==== | ||
*If the case is underlying [[malignancy]], [[chemotherapy]] or [[radiotherapy]] may transiently exacerbate [[anemia]] due to [[Bone marrow suppression|mylesuppressive]] effects, however in the long term, it leads to improvement. | |||
*If the cause is [[Inflammatory|inflammatory disorder]], such as [[rheumatoid arthritis]] the management of the disease with a [[disease-modifying antirheumatic drug]] [[DMARD|(DMARD]]) improves the [[anemia]] significantly. | |||
*If the root cause of [[anemia]] is not found, a detailed search for [[Inflammatory|inflammatory disorders]] such as [[inflammatory bowel disease]] and [[malignancy]] should be carried. | |||
*It is recommended to start with age-appropriate health [[Screening (medicine)|screening]]. | |||
==References== | ==References== | ||
Revision as of 20:49, 2 October 2018
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Anemia of chronic disease Microchapters | |
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Differentiating Anemia of chronic disease from other Diseases | |
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Diagnosis | |
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Anemia of chronic disease medical therapy On the Web | |
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American Roentgen Ray Society Images of Anemia of chronic disease medical therapy | |
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Risk calculators and risk factors for Anemia of chronic disease medical therapy | |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Medical Therapy
Supplemental iron:
- Supplemental iron is recommended, as needed, to keep the transferrin saturation of above 20 percent and a serum ferritin level of above100 ng/mL.
Intravenous iron:
- Intravenous iron is more effective than oral supplementaion.
- Intestinal absorption of iron is greatly reduced due to hepcidin activity at intestinal lining.
- Hepcidin-induced entrapment of iron can be managed with parenteral iron infusions.
Erythropoietin:
In case of patients who do not respond to oral or parenteral iron infusions erythropoietin should be considered.
- Stable patients can be administered synthetically prepared erythropoiesis-stimulating agent such as erythropoietin.
- Erythropoietin can be given once per week, while darbepoetin should be administered once every two or three weeks.
- It is important to give oral iron supplementation to all the patients receiving erythropoietin or darbepoetin, in order to maintain a transferrin saturation more than 20 percent and a serum ferritin more than 100 ng/mL.
Blood Transfusion:
- In case of severe disease, blood transfusion is recommended.
In majority of cases, treatment of the underlying disorder is more effective:
- If the case is underlying malignancy, chemotherapy or radiotherapy may transiently exacerbate anemia due to mylesuppressive effects, however in the long term, it leads to improvement.
- If the cause is inflammatory disorder, such as rheumatoid arthritis the management of the disease with a disease-modifying antirheumatic drug (DMARD) improves the anemia significantly.
- If the root cause of anemia is not found, a detailed search for inflammatory disorders such as inflammatory bowel disease and malignancy should be carried.
- It is recommended to start with age-appropriate health screening.