From the Guidelines
Treatment of anemia of chronic disease should focus on addressing the underlying condition causing inflammation, and when specific treatment is needed for the anemia itself, options include iron supplementation and erythropoiesis-stimulating agents (ESAs), with a target hemoglobin level not above 12 g/dL 1.
Key Considerations
- The presence of anemia of chronic disease is a clear indicator of active disease, and optimization of underlying disease treatment should precede any ESA treatment 1.
- Iron supplementation is recommended in all patients with iron-deficiency anemia, and intravenous iron is more effective and better tolerated than oral iron, especially in patients with clinically active disease or previous intolerance to oral iron 1.
- ESAs like epoetin alfa or darbepoetin alfa may be considered when hemoglobin levels fall below 10 g/dL and symptoms are present, but they carry risks of hypertension and thrombotic events, requiring careful monitoring 1.
Diagnostic Criteria
- Serum ferritin <30 mg/L is an appropriate criterion for the diagnosis of iron deficiency anemia in patients without clinical, endoscopic, or biochemical evidence of active disease 1.
- In the presence of inflammation, a serum ferritin up to 100 mg/L may still be consistent with iron deficiency, and a combination of true iron deficiency and anemia of chronic disease is likely if the serum ferritin level is between 30 and 100 mg/L 1.
Treatment Approach
- Intravenous iron should be considered as first-line treatment in patients with clinically active IBD, with previous intolerance to oral iron, with hemoglobin below 100 g/L, and in patients who need erythropoiesis-stimulating agents 1.
- Oral iron may be used in patients with mild anemia, whose disease is clinically inactive, and who have not been previously intolerant to oral iron 1.
- After successful treatment of iron deficiency anemia with intravenous iron, re-treatment with intravenous iron should be initiated as soon as serum ferritin drops below 100 mg/L or hemoglobin below 120 or 130 g/L according to gender 1.
From the FDA Drug Label
1 INDICATIONS AND USAGE
1.1 Anemia Due to Chronic Kidney Disease Epogen 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. The treatment for anemia of chronic disease is not directly addressed in the provided drug label. However, it does mention the treatment of anemia due to chronic kidney disease using epoetin alfa.
- The drug label does not provide information on the treatment of anemia of chronic disease caused by other conditions.
- Epoetin alfa may be used to treat anemia due to chronic kidney disease, but its use in other types of anemia of chronic disease is not specified 2. The FDA drug label does not answer the question.
From the Research
Treatment of Anemia of Chronic Disease
The treatment of anemia of chronic disease involves addressing the underlying condition and managing the anemia itself. The main features of anemia of chronic diseases include:
- Mild to moderate lowering of hemoglobin level
- Decreased percentage of reticulocyte count
- Low iron and transferrin concentration, but increased ferritin
Treatment Approaches
Treatment approaches for anemia of chronic disease include:
- Supplementation with iron, folic acid, and vitamin B12 3
- A diet rich in hematopoietic factors 3
- Red cell transfusions in severe anemia 4
- Erythropoiesis stimulating agents in more severe anemias 4, 5
- Recombinant human erythropoietin (r-HuEPO) treatment to increase hematocrit level 5, 6
- Parenteral iron supplementation in cases of iron-deficient erythropoiesis 6
Considerations for Treatment
When considering treatment, it is essential to:
- Undertake in-depth diagnostics, including assessment of complete blood count and biochemical parameters, as well as severity of the underlying disease 3
- Exclude other types of anemia, particularly iron deficiency anemia 3, 4
- Carefully consider the benefits and possible side effects of different treatment approaches 3, 4