Anemia of chronic disease medical therapy
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Medical Therapy
- The primary goal in the treatment of anemia of chronic disease it to treat the disease itself.
Supplemental iron:
- Supplemental iron is recommended, as needed, to keep the transferrin saturation of above 20 percent and a serum ferritin level of ≥100 ng/mL.
- Intravenous iron is more effective than oral iron.
- Intestiona absorption of iron is greatly reduced due to hepcidin activity at intestinal lining.
- Hepcidin induced entrampment of iran can be managed with parentral iron infusions.
- In case of severe disease blood transfusion is recommended.
- Stable patients can be given synthetically prepared erythropoiesis-stimulating agent such as erythropoietin.
- EPO can be given once per week, while darbepoetin has an effectiveness equal to that of EPO when given once every two or three weeks. Supplemental iron should be given in all patients receiving EPO or darbepoetin in order to maintain a transferrin saturation ≥20 percent and a serum ferritin ≥100 ng/mL. Such use of erythropoiesis-stimulating agents is considered "unlabeled or investigational" in the United States and may not be reimbursed.
In majority of cases, treatment of the underlying disorder is more effective:
- If the case is underlying malignancy, chemothearpy or radiotherapy may transiently exaxerbate 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.