From the Guidelines
Low hematocrit (Hct) and hemoglobin (HGB) without active bleeding can be caused by several underlying conditions, with iron deficiency being a common cause, as well as infection/inflammation, chronic blood loss, osteitis fibrosa, aluminum toxicity, hemoglobinopathies, folate or vitamin B12 deficiency, multiple myeloma, malnutrition, and hemolysis, as outlined in the NKF-K/DOQI clinical practice guidelines for anemia of chronic kidney disease 1.
Potential Causes
Some of the potential causes of low Hct and HGB without active bleeding include:
- Iron deficiency, which can result from inadequate iron intake, malabsorption, or chronic blood loss
- Infection/inflammation, such as access infections, surgical inflammation, AIDS, or SLE, which can impair responsiveness to Epoetin therapy 1
- Chronic blood loss, which can lead to iron deficiency and impaired Epoetin response
- Osteitis fibrosa, which can replace active marrow erythroid elements with fibrosis, impairing response to Epoetin
- Hemoglobinopathies, such as alpha and beta thalassemias, or sickle cell anemia
- Folate or vitamin B12 deficiency, which can impair erythropoiesis
- Multiple myeloma, which can lead to anemia due to bone marrow infiltration
- Malnutrition, which can impair erythropoiesis
- Hemolysis, which can lead to anemia due to premature red blood cell destruction
Evaluation and Treatment
Evaluation of low Hct and HGB without active bleeding typically involves a complete blood count, peripheral blood smear, reticulocyte count, iron studies, vitamin B12 and folate levels, and possibly bone marrow examination. Treatment depends on identifying and addressing the underlying cause, which may include iron supplementation, vitamin supplementation, erythropoietin therapy, or management of chronic conditions, as outlined in the NKF-K/DOQI clinical practice guidelines for anemia of chronic kidney disease 1.
From the FDA Drug Label
Correct or exclude other causes of anemia (e. g., vitamin deficiency, metabolic or chronic inflammatory conditions, bleeding, etc.) before initiating PROCRIT. The reason for Hct and HGB to be low without active bleeding may be due to:
- Vitamin deficiency
- Metabolic conditions
- Chronic inflammatory conditions 2
From the Research
Low Hematocrit (Hct) and Hemoglobin (HGB) without Active Bleeding
- Low Hct and HGB levels can be caused by various factors, including iron deficiency anemia, which is a common complication of chronic kidney disease (CKD) 3.
- Iron deficiency anemia can be absolute, defined by severely reduced or absent iron stores, or functional, defined by adequate iron stores but insufficient iron availability for incorporation into erythroid precursors 3.
- Other causes of low Hct and HGB without active bleeding include:
- Iron malabsorption due to atrophic gastritis, celiac disease, chronic inflammation, or bariatric surgery 4
- Chronic blood loss due to gastrointestinal ulcerations 4
- Decreased dietary iron and decreased iron absorption 5
- Chronic inflammatory conditions, such as congestive cardiac failure, chronic kidney disease, and inflammatory bowel disease 5, 6
- Diagnosis of iron deficiency anemia involves measuring serum ferritin and transferrin saturation, which are key tests in early decision-making process to identify iron deficiency anemia (IDA) 6.
- Treatment of iron deficiency anemia is based on iron supplementation, with oral iron preparations being effective in most cases, while parenteral iron dextran is effective in cases of malabsorption or true intolerance 7.