From the Guidelines
Severe anemia with a hemoglobin level of 6.3 g/dL should be treated with red blood cell transfusion, as the hemoglobin concentration is below the threshold of 7 g/dL, and this is a recommended approach according to the European consensus on the diagnosis and management of iron deficiency and anaemia in inflammatory bowel diseases 1.
Treatment Approach
The treatment should start with the administration of 1-2 units of packed red blood cells, with each unit expected to raise hemoglobin by approximately 1 g/dL.
- This approach is based on the principle that blood transfusions are widely used as an immediate intervention for rapid correction of severe or life-threatening anaemia 1.
- However, it is essential to note that transfusions do not correct the underlying pathology and have no lasting effect, so other options should be considered ahead of and after transfusions 1.
Investigation and Treatment of Underlying Cause
After the initial transfusion, it is crucial to investigate and treat the underlying cause of the anemia.
- Iron supplementation is often necessary, typically with oral ferrous sulfate 325 mg three times daily or ferrous gluconate 300 mg twice daily.
- For patients who cannot tolerate oral iron or have malabsorption, intravenous iron formulations such as iron sucrose or ferric carboxymaltose may be used, as recommended by the European consensus on the diagnosis and management of iron deficiency and anaemia in inflammatory bowel diseases 1.
Monitoring and Follow-up
Patients should be monitored with repeat hemoglobin measurements every few days initially, then weekly until stable.
- This aggressive approach is necessary because hemoglobin levels below 7 g/dL significantly impair oxygen delivery to tissues, potentially causing organ dysfunction, cardiac complications, and fatigue.
- The treatment aims to quickly restore adequate oxygen-carrying capacity while addressing the root cause of the anemia, as supported by the European consensus on the diagnosis and management of iron deficiency and anaemia in inflammatory bowel diseases 1.
From the Research
Treatment for Severe Anemia
The treatment for severe anemia with a hemoglobin level of 6.3 g/dL depends on the underlying cause of the anemia.
- If the anemia is due to iron deficiency, treatment with intravenous iron may be effective, as seen in a study where patients with chronic kidney disease and iron deficiency anemia showed a significant increase in hemoglobin levels after receiving intravenous iron 2.
- If the anemia is due to vitamin B12 deficiency, treatment with vitamin B12 supplements may be necessary, as vitamin B12 plays a crucial role in DNA synthesis and erythropoiesis 3, 4.
- In cases where the anemia is due to a combination of iron and vitamin B12 deficiencies, treatment with both intravenous iron and vitamin B12 supplements may be required, as seen in a case report of a patient with hemolytic anemia secondary to vitamin B12 deficiency with concomitant iron deficiency anemia 5.
- For anemia of inflammation, such as in chronic kidney disease, treatment options include oral iron supplements, intravenous iron, erythropoietin, and blood transfusion, depending on the severity and comorbidities of the patient 6.
Diagnostic Considerations
- It is essential to establish the correct diagnosis of the underlying cause of the anemia, as treatment directed at the wrong deficiency may hide the real deficiency with disastrous results 4.
- Specific diagnostic tests, such as serum ferritin and transferrin saturation, gastric analysis, small-bowel x-ray films, and the Schilling test, can help determine the definitive diagnosis of the anemia 3, 4.