From the Guidelines
Management of severe anemia with a hemoglobin level of 7.5 and a serum ferritin level of 55 requires identifying the underlying cause while providing appropriate treatment, and given the severity of the anemia, blood transfusion is likely indicated regardless of cause. Initial steps include a complete blood count with reticulocyte count, peripheral blood smear, and additional testing for hemolysis, vitamin deficiencies, and chronic disease 1. The serum ferritin level of 55, although within the normal range, may not entirely rule out iron deficiency in the context of inflammation, as a level up to 100 mg/L can be consistent with iron deficiency in such cases 1. However, given the information provided, the primary focus should be on addressing the severe anemia.
Treatment depends on the specific etiology: for hemolytic anemia, address the underlying cause and consider corticosteroids or immunosuppressants; for vitamin B12 deficiency, administer cyanocobalamin 1000 mcg intramuscularly daily for one week, then weekly for four weeks, followed by monthly injections; for folate deficiency, prescribe folic acid 1-5 mg daily. Anemia of chronic disease may require erythropoiesis-stimulating agents like epoetin alfa 50-100 units/kg three times weekly. In cases of thalassemia, supportive care with blood transfusions may be necessary.
Given the severe anemia (hemoglobin 7.5), blood transfusion is often indicated regardless of cause, especially if the patient is symptomatic, to rapidly improve oxygen delivery to tissues and organs. Ongoing monitoring includes regular hemoglobin checks and assessment of response to therapy. Identifying the specific mechanism of anemia is crucial for effective management, but in the immediate term, addressing the severe anemia takes precedence. The recent guideline from the American Gastroenterological Association 1 emphasizes the importance of iron repletion to improve quality of life and decrease the risk of complications related to anemia, but in this case, the immediate concern is the severe anemia itself.
From the Research
Management of Severe Anemia with Normal Serum Ferritin Levels
- The patient's condition, with a hemoglobin level of 7.5 and serum ferritin of 55, indicates severe anemia but with normal serum ferritin levels, which can be challenging to manage 2, 3.
- Studies have shown that intravenous iron can be effective in treating anemia in patients with chronic kidney disease, even with normal serum ferritin levels 2, 3.
- Oral iron supplementation can also be effective, especially when used in combination with other therapies such as sodium-glucose co-transporter 2 inhibitors 4.
- The choice of treatment should be based on the individual patient's needs and medical history, as well as the underlying cause of the anemia 5, 6.
Treatment Options
- Intravenous iron: can be effective in rapidly increasing hemoglobin levels, but may have adverse effects such as hypotension and allergic reactions 2, 3.
- Oral iron: can be effective in increasing hemoglobin levels, but may have gastrointestinal side effects and may not be as rapid-acting as intravenous iron 6, 4.
- Erythropoiesis-stimulating agents: may be used in combination with iron supplementation to stimulate red blood cell production, but may have adverse effects such as thrombocytosis and increased mortality risk 3.
Monitoring and Follow-up
- Regular monitoring of hemoglobin levels, serum ferritin, and other iron biomarkers is essential to assess the effectiveness of treatment and adjust the treatment plan as needed 2, 3, 4.
- Patients should be followed up regularly to monitor for adverse effects and adjust the treatment plan to minimize risks and optimize benefits 5, 6.