What is the treatment for anemia?

From the Guidelines

Treatment of Anemia

The treatment of anemia typically involves iron supplementation with ferrous sulfate 325mg orally three times daily for a minimum of 3-6 months 1.

• In cases of severe anemia, intravenous iron formulations such as ferric gluconate or iron dextran may be administered, with dosages ranging from 1-4 grams infused over 1-5 hours 1.
• Erythropoiesis-stimulating agents like epoetin alfa 10,000-20,000 units subcutaneously weekly may be considered in patients with chronic kidney disease or other underlying conditions, and should be combined with intravenous iron supplementation 1.
• Vitamin B12 and folate supplements may also be prescribed if deficiencies are identified 1.

Special Considerations

• Red blood cell transfusion may be considered when hemoglobin concentration is below 7 g/dL, or above if symptoms or particular risk factors are present, and should be followed by subsequent intravenous iron supplementation 1.
• The decision to administer blood transfusions is not solely based on the hemoglobin level, but takes comorbidity and symptoms into account 1.
• Treating the underlying cause of anemia, such as inflammatory bowel disease, is also an important part of management 1.

From the FDA Drug Label

PROCRIT 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. PROCRIT is indicated for the treatment of anemia due to zidovudine administered at ≤ 4200 mg/week in patients with HIV Infection with endogenous serum erythropoietin levels of ≤ 500 mUnits/mL. PROCRIT is indicated for the treatment of anemia in patients with non-myeloid malignancies where anemia is due to the effect of concomitant myelosuppressive chemotherapy, and upon initiation, there is a minimum of two additional months of planned chemotherapy.

The treatment for anemia is epoetin alfa (PROCRIT), which works like the human protein called erythropoietin to help the body make more red blood cells (RBCs). It is used to reduce or avoid the need for RBC transfusions in patients with:

• Chronic kidney disease (CKD)
• Anemia due to zidovudine in patients with HIV infection
• Anemia due to chemotherapy in patients with cancer
• Perisurgery to reduce the need for allogeneic RBC transfusions in patients undergoing elective, noncardiac, nonvascular surgery 2 2

From the Research

Treatment Options for Anemia

• Iron supplementation is a cornerstone of anemia management, and it can be administered orally or intravenously 3, 4, 5, 6, 7.
• Oral iron preparations are commonly prescribed due to their convenience and low cost, but their efficacy is limited by reduced absorption rates and gastrointestinal side effects 3.
• Intravenous (IV) iron is an alternative treatment option, which can bypass hepcidin actions and make iron available to macrophages, and it has been shown to be effective in managing iron-deficiency anemia (IDA) 3, 4, 5, 6, 7.

Comparison of IV and Oral Iron Supplementation

• Studies have compared the efficacy of IV and oral iron supplementation in patients with chronic kidney disease (CKD), and the results suggest that IV iron is more effective in increasing hemoglobin levels and replenishing iron stores 4, 5, 7.
• However, oral liposomal iron has been shown to be a safe and effective option for correcting anemia in non-dialysis CKD patients, although it may have lower efficacy in replenishing iron stores compared to IV iron 4.
• A systematic review and meta-analysis found that IV iron was associated with a higher risk of hypotension, but fewer gastrointestinal adverse events compared to oral iron 7.

Specific Patient Populations

• For patients with CKD stages 3 to 5, IV iron replacement was associated with a higher likelihood of reaching an hemoglobin response > 1g/dL compared to oral iron 7.
• For patients with CKD stage 5D, IV iron is preferred due to its ability to rapidly correct iron deficiency and improve hemoglobin levels 7.
• For non-hemodialysis-dependent patients with CKD, the evidence does not support the use of IV iron over oral iron to treat iron deficiencies, although IV iron may be more effective in increasing ferritin and transferrin saturation levels 6.