What is the treatment for anemia?

Treatment of Anemia

The treatment of anemia must be tailored to the underlying cause, with iron supplementation being the first-line therapy for iron deficiency anemia, which is the most common type worldwide. 1

Diagnosis and Classification

Before initiating treatment, proper diagnosis is essential:

• Anemia is defined as a reduction in hemoglobin concentration, red-cell count, or packed cell volume below normal levels 2

• Classification by severity 2:

  • Mild: Hb ≤11.9 g/dl and ≥10 g/dl
  • Moderate: Hb ≤9.9 and ≥8.0 g/dl
  • Severe: Hb <8.0 g/dl

• Diagnostic workup should include 2:

  • Complete blood count with reticulocyte count
  • Iron studies (serum iron, ferritin, transferrin saturation)
  • Vitamin B12 and folate levels
  • Peripheral blood smear
  • Assessment for occult blood loss in stool and urine

Treatment by Type of Anemia

Iron Deficiency Anemia

• Oral iron supplementation is first-line therapy 3, 1:

  • Ferrous sulfate 324 mg (65 mg elemental iron) daily or twice daily 3
  • Administer between meals to maximize absorption 2
  • Continue treatment for 2-3 months after hemoglobin normalization to replenish iron stores 2

• Parenteral iron therapy is indicated when 1, 4:

  • Oral iron is not tolerated
  • Malabsorption is present
  • Rapid repletion is needed

• Treat the underlying cause 2:

  • Investigate and address gastrointestinal blood loss in men and postmenopausal women
  • Upper and lower gastrointestinal endoscopy may be required

Anemia of Chronic Disease/Inflammation

• Address the underlying condition (infection, autoimmune disease, cancer, etc.) 5, 6
• Consider iron supplementation if concurrent iron deficiency exists 5
• Erythropoiesis-stimulating agents (ESAs) may be considered in specific situations 6:
  • Not recommended for mild to moderate anemia with heart disease 2
  • May be appropriate for chemotherapy-induced anemia with Hb ≤10 g/dl 2

Cancer and Chemotherapy-Induced Anemia

• Treatment options include 2:

  • Red blood cell transfusions for severe symptomatic anemia
  • ESAs for patients with chemotherapy-induced anemia and Hb ≤10 g/dl
  • Iron supplementation, particularly if iron deficiency is present

• ESAs should be used with caution in patients treated with curative intent 2

Anemia in Heart Disease

• Use a restrictive red blood cell transfusion strategy (trigger Hb threshold of 7-8 g/dl) 2
• Avoid ESAs in patients with mild to moderate anemia and heart disease 2
• Consider iron replacement therapy if iron deficiency is present 2

Special Considerations

Transfusion Therapy

• Reserved for severe symptomatic anemia or when rapid correction is needed 2
• Use restrictive transfusion strategy (Hb trigger 7-8 g/dl) to minimize complications 2
• Potential complications include iron overload, infection transmission, and immune suppression 2

Genetic Disorders of Iron Metabolism

• Specialized treatment approaches are required for rare genetic disorders affecting iron metabolism or heme synthesis 2
• May require combination therapy with iron, erythropoietin, and/or transfusions 2

Monitoring and Follow-up

• For iron deficiency anemia 2:

  • Repeat hemoglobin measurement after 4 weeks of treatment
  • An increase in Hb ≥1 g/dl confirms response to iron therapy
  • Continue treatment for 2 more months after correction
  • Reassess 6 months after successful treatment

• For other types of anemia:

  • Monitor based on the underlying condition and treatment approach
  • Regular assessment of iron status and hemoglobin levels

Pitfalls and Caveats

• Failure to identify and treat the underlying cause can lead to recurrence 2, 1
• Excessive iron supplementation can cause gastrointestinal side effects and potential iron overload 1
• ESAs carry risks including hypertension, thromboembolism, and potential tumor progression in cancer patients 2
• Transfusions should be used judiciously due to associated risks 2