How to manage anemia (low hematocrit)?

From the Guidelines

Anemia management should focus on treating the underlying cause, with iron therapy being a reasonable option for patients with iron deficiency anemia.

Anemia Diagnosis and Management

• The World Health Organization defines anemia as a hemoglobin concentration <13 g/dL in men and <12 g/dL in women 1.
• Iron deficiency is responsible for 40% to 50% of anemia cases, and can be identified by a ferritin concentration <100 ng/mL, transferrin saturation <20%, and/or microcytic hypochromic red cells 1.
• A screening system that automatically triggers evaluation for iron deficiency using previously collected blood can identify iron-deficiency anemia more effectively than traditional methods 1.

Treatment Options

• Iron therapy, either oral or intravenous, is a reasonable option for patients with iron deficiency anemia, particularly in the preoperative setting for elective noncardiac surgery 1.
• The choice of iron formulation and dosage depends on the individual patient's needs and medical history.
• Transfusion thresholds should be restrictive, with a hemoglobin threshold of 8 g/dL recommended for orthopedic surgery patients and those with cardiovascular disease 1.

Monitoring and Follow-up

• Patients with anemia should be monitored regularly, with follow-up intervals of 3 months for 1 year, then annually, and as needed if symptoms recur 1.
• Hemoglobin levels and red cell indices should be checked at each follow-up visit, with further oral iron therapy given if the hemoglobin or red cell indices fall below normal 1.

From the Research

Management of Anemia

To manage anemia, also known as low hematocrit, several approaches can be considered:

• Transfusion thresholds: According to 2, the majority of physicians recommend red cell transfusion in patients with a hematocrit <25%. However, this threshold may vary depending on the presence of cardiovascular disease and advanced age.
• Use of human recombinant erythropoietin: As reported in 2, 46% of physicians recommend the use of human recombinant erythropoietin in anemic patients.
• Iron supplementation: The treatment of iron deficiency should always be initiated with oral iron, as stated in 3. When this fails, parenteral iron can be given using iron dextran, iron gluconate, or iron sucrose.
• Monitoring of erythropoietic parameters: An anemia management protocol can help nurses and other clinicians monitor and manage erythropoietic parameters, as described in 4.

Diagnosis of Iron Deficiency

For the diagnosis of iron deficiency, the following measures can be used:

• Serum ferritin: As an index of iron stores, as mentioned in 3.
• Serum transferrin receptor: As an index of tissue iron deficiency, as mentioned in 3.
• Reticulocyte hemoglobin content (CHr): A new hematologic parameter that can be used in addition to the screening complete blood count (CBC) to improve detection of iron deficiency and iron deficiency anemia, as reported in 5.

Treatment of Iron Deficiency

The treatment of iron deficiency should always be initiated with oral iron, as stated in 3. When this fails, parenteral iron can be given using iron dextran, iron gluconate, or iron sucrose. Additionally, an algorithm using CHr measurement can be used to screen for iron deficiency anemia, enabling early detection and treatment of iron deficiency, as described in 5.