Anemia of chronic disease medical therapy
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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.