What is the diagnosis and treatment for anemia?

From the Guidelines

Anemia should be managed with iron replacement therapy, and the route of administration should be chosen based on the severity of the anemia, patient tolerance, and underlying cause, with intravenous iron formulations being more effective and better tolerated than oral iron in certain cases, as recommended by the British Society of Gastroenterology guidelines for the management of iron deficiency anaemia in adults 1.

Causes and Diagnosis of Anemia

Anemia can result from various causes, including iron deficiency, vitamin B12 or folate deficiency, chronic disease, or blood loss. The diagnosis of anemia involves blood tests to determine the type and severity of the anemia.

• Iron deficiency anemia is the most common type and can be diagnosed by low serum ferritin levels and transferrin saturation.
• Vitamin B12 deficiency anemia requires B12 supplementation, typically 1000 mcg daily orally or monthly injections.
• Folate deficiency is treated with folic acid supplements, usually 1 mg daily.

Treatment of Anemia

Treatment of anemia depends on the underlying cause and severity.

• For iron deficiency anemia, oral iron supplements such as ferrous sulfate (325 mg) taken 1-3 times daily between meals with vitamin C to enhance absorption is typically recommended for 3-6 months.
• For severe cases or those who cannot tolerate oral supplements, intravenous iron formulations may be necessary, as they have been shown to be more effective and better tolerated than oral iron in certain cases, such as in patients with inflammatory bowel disease 1.
• Regular blood tests are important for monitoring treatment effectiveness, and dietary changes to include iron-rich foods (red meat, beans, leafy greens), vitamin B12 (animal products), and folate (leafy greens, citrus) can support recovery alongside medical treatment.

Recent Guidelines and Recommendations

Recent guidelines and recommendations emphasize the importance of individualized treatment approaches, taking into account the underlying cause of anemia, patient preferences, and potential risks and benefits of different treatments.

• The Kidney Disease: Improving Global Outcomes (KDIGO) conference highlighted the need for a reevaluation of the 2012 KDIGO guideline on anemia in chronic kidney disease, considering new therapies such as hypoxia-inducible factor-prolyl hydroxylase inhibitors (HIF-PHIs) 1.
• The American College of Physicians recommends against the use of erythropoiesis-stimulating agents in patients with mild to moderate anemia and congestive heart failure or coronary heart disease, due to the potential for adverse outcomes 1.

From the FDA Drug Label

PROCRIT is indicated for the treatment of anemia due to chronic kidney disease (CKD), including patients on dialysis and not on dialysis to decrease the need for red blood cell (RBC) transfusion. PROCRIT is indicated for the treatment of anemia due to zidovudine administered at ≤ 4200 mg/week in HIV-infected patients with endogenous serum erythropoietin levels of ≤ 500 mUnits/mL. PROCRIT is indicated for the treatment of anemia in patients with non-myeloid malignancies where anemia is due to the effect of concomitant myelosuppressive chemotherapy, and upon initiation, there is a minimum of two additional months of planned chemotherapy.

Anemia Treatment: Erythropoietin (IV) is indicated for the treatment of anemia due to:

• Chronic kidney disease (CKD)
• Zidovudine in HIV-infected patients
• Chemotherapy in patients with non-myeloid malignancies The dosage should be individualized and the lowest dose sufficient to reduce the need for RBC transfusions should be used 2.

From the Research

Definition and Causes of Anemia

• Anemia is a condition characterized by a reduced red blood cell (RBC) mass from any cause 3
• The causes of anemia are numerous and can be due to decreased (or abnormal) erythropoiesis, shortened RBC life span, or blood loss 3
• The most common etiology of anemia is iron deficiency 3, 4, 5

Diagnosis and Laboratory Tests

• A judicious workup of anemia includes evaluating the reticulocyte count and peripheral smear 3
• The first-line laboratory test for patients suspected of being anemic is the full blood count 6
• Laboratory measurement of the concentration in blood of iron, vitamin B12, and folate can help in the differential diagnosis of anemic patients 6

Management and Treatment

• Management of patients with hereditary and hemolytic anemias should involve a hematologist 3
• Oral iron therapy is the first line of treatment in most cases of iron deficiency anemia 4, 5
• Intravenous (IV) iron administration is the preferred route for patients intolerant of or unresponsive to oral iron 5
• IV iron is safe and effective in all clinical circumstances, including pregnancy 5

Relationship between Iron Deficiency and Other Nutritional Deficiencies

• Iron deficiency can affect many metabolic pathways, including vitamin B12 and folate 7
• Treatment with iron can increase serum folate and vitamin B12 levels in young adult women with iron deficiency anemia 7
• Healthcare practitioners should be aware of these changes in iron deficiency anemia management 7