From the Guidelines
Monitoring in Patients with Chronic Anemia
Patients with chronic anemia should be monitored for iron deficiency, kidney function, and hemoglobin levels.
- Key parameters to monitor include:
- Hemoglobin (Hb) levels: to assess the severity of anemia and response to treatment 1
- Iron parameters: such as serum iron, total iron-binding capacity (TIBC), transferrin saturation (TSAT), and serum ferritin to evaluate iron stores and availability for erythropoiesis 1
- Reticulocyte count: to assess bone marrow response and detect potential hemolysis 1
- Kidney function: including glomerular filtration rate (GFR) to identify chronic kidney disease (CKD) as a potential cause of anemia 1
Monitoring Frequency
- More frequent monitoring may be necessary in patients with diabetes or those undergoing hemodialysis 1
- Timing of monitoring: consider measuring hemoglobin levels before midweek dialysis sessions in patients on hemodialysis, as levels can vary significantly 1
Special Considerations
- Recurrent iron deficiency: monitor patients with a history of iron deficiency anemia (IDA) every 3 months for at least a year after correction, and periodically thereafter, especially in those with inflammatory bowel disease (IBD) 1
- Anaemia of chronic disease: distinguish from IDA, especially in elderly patients or those with multiple comorbidities, using reflex testing and electronic healthcare records 1
From the Research
Monitoring Parameters
To monitor patients with chronic anemia, the following parameters should be considered:
- Hemoglobin level: to assess the severity of anemia 2, 3, 4, 5
- Hematocrit and erythrocyte counts: to evaluate the decrease in red blood cell production 2
- Reticulocyte count: to assess the bone marrow's response to anemia 2
- Iron and transferrin concentration: to evaluate iron deficiency 2, 3, 4
- Ferritin level: to assess iron stores 2, 3, 4
- Hepcidin level: to evaluate its role in iron metabolism and anemia of chronic disease 2, 4, 5
- Erythropoietin level: to assess the body's ability to produce red blood cells 2, 4, 5
- Biochemical parameters: such as creatinine and vitamin B12 levels, to evaluate the underlying disease and anemia 2, 4
Underlying Disease Assessment
It is essential to assess the severity of the underlying disease, as anemia of chronic disease is often correlated with the severity of the underlying condition 2, 3, 4, 5. This includes evaluating the patient's clinical status, disease progression, and response to treatment.
Treatment Monitoring
Patients with chronic anemia should be monitored for their response to treatment, including:
- Iron supplementation: to assess the effectiveness of iron therapy and potential side effects 2, 3, 4
- Erythropoiesis-stimulating agents (ESAs): to evaluate their effectiveness in increasing red blood cell production 3, 4, 5
- Blood transfusion: to assess the need for transfusion and potential risks 3, 4, 6