From the Guidelines
Neuromyelitis optica (NMO) patients may develop anemia due to various factors, including immunosuppressive medications and corticosteroid treatment, and managing anemia is crucial to improve patient well-being and potentially enhance recovery from NMO attacks. The provided evidence primarily focuses on anemia in the context of inflammatory bowel disease (IBD), but the principles of anemia diagnosis and management can be applied to other conditions, including NMO. According to the most recent and highest quality study 1, iron deficiency anaemia is a common extraintestinal manifestation of IBD, and its management is crucial to improve quality of life and reduce morbidity. Key points to consider in managing anemia in NMO patients include:
- Regular complete blood counts to monitor for anemia
- Iron supplementation for iron deficiency, typically with ferrous sulfate 325 mg three times daily
- Vitamin B12 supplementation for B12 deficiency, typically with 1000 mcg daily initially
- Dose adjustment of immunosuppressants if medication-induced anemia occurs
- Consideration of other causes of anemia, such as folate deficiency or bone marrow depression The study by 1 also highlights the importance of measuring serum ferritin and transferrin saturation to diagnose iron deficiency anaemia, especially in patients with inflammation. Additionally, the study by 1 provides guidance on the estimation of iron need and the use of intravenous iron therapy in patients with IBD, which may be applicable to NMO patients with severe anemia. Overall, managing anemia in NMO patients requires a comprehensive approach that takes into account the underlying cause of anemia and the patient's individual needs.
From the Research
Neuromyelitis Optica and Anemia
- Neuromyelitis optica (NMO) is a clinical syndrome characterized by attacks of acute optic neuritis and transverse myelitis, often caused by pathogenetic serum IgG autoantibodies to aquaporin 4 (AQP4) 2.
- NMO has been associated with other autoimmune conditions, including autoimmune hemolytic anemia, which is a condition where the immune system produces antibodies that attack and destroy red blood cells 3.
- The coexistence of multiple immunologic abnormalities in patients with NMO and autoimmune hemolytic anemia points to a generalized dysfunction of the humoral immune system 3.
- Treatment options for NMO are currently based on small retrospective case series and open label studies, and may include immunosuppressants such as rituximab, azathioprine, mycophenolate, and cyclophosphamide 4.
- Rituximab has been shown to significantly reduce relapse rates and improve disability in patients with NMO, while maintaining comparable tolerability to other immunosuppressive treatments 4.
Pathophysiology and Treatment
- NMO is caused by a pathogenic serum IgG antibody against the water channel aquaporin 4 (AQP4) in the majority of patients, which binds to AQP4 channels on astrocytes and triggers an immune response leading to demyelination and neuronal loss 5.
- The primary objective in disease management is to suppress relapse frequency and severity, and current treatments include steroids and plasma exchange for acute relapses, and immunosuppressants for long-term relapse prevention 5.
- Recent clinical trials have expanded the spectrum of drugs available for NMO patients, including satralizumab, an interleukin-6 receptor (IL-6R) inhibitor, inebilizumab, an antibody against CD19+ B cells, and eculizumab, an antibody blocking the C5 component of complement 5.