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.[2]
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.[3]
- Stable patients can be administered synthetically prepared erythropoiesis-stimulating agent such as erythropoietin.[4]
- 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.
Alternative Options
- Recent studies a
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.[5]
- 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.
References
- ↑ Zarychanski R, Houston DS (August 2008). "Anemia of chronic disease: a harmful disorder or an adaptive, beneficial response?". CMAJ. 179 (4): 333–7. doi:10.1503/cmaj.071131. PMC 2492976. PMID 18695181.
- ↑ Auerbach M, Ballard H, Trout JR, McIlwain M, Ackerman A, Bahrain H, Balan S, Barker L, Rana J (April 2004). "Intravenous iron optimizes the response to recombinant human erythropoietin in cancer patients with chemotherapy-related anemia: a multicenter, open-label, randomized trial". J. Clin. Oncol. 22 (7): 1301–7. doi:10.1200/JCO.2004.08.119. PMID 15051778.
- ↑ Spivak JL (August 1994). "Recombinant human erythropoietin and the anemia of cancer". Blood. 84 (4): 997–1004. PMID 8049455.
- ↑ Lind M, Vernon C, Cruickshank D, Wilkinson P, Littlewood T, Stuart N, Jenkinson C, Grey-Amante P, Doll H, Wild D (April 2002). "The level of haemoglobin in anaemic cancer patients correlates positively with quality of life". Br. J. Cancer. 86 (8): 1243–9. doi:10.1038/sj.bjc.6600247. PMC 2375336. PMID 11953880.
- ↑ Cash JM, Sears DA (December 1989). "The anemia of chronic disease: spectrum of associated diseases in a series of unselected hospitalized patients". Am. J. Med. 87 (6): 638–44. PMID 2589399.