Anemia of chronic disease medical therapy: Difference between revisions
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==Overview== | ==Overview== | ||
==Medical Therapy== | ==Medical Therapy== | ||
*The primary goal in the treatment of [[anemia]] of chronic disease it to treat the [[disease]] itself. | *The primary goal in the treatment of [[anemia]] of chronic disease it to treat the [[disease]] itself.<ref name="pmid18695181">{{cite journal |vauthors=Zarychanski R, Houston DS |title=Anemia of chronic disease: a harmful disorder or an adaptive, beneficial response? |journal=CMAJ |volume=179 |issue=4 |pages=333–7 |date=August 2008 |pmid=18695181 |pmc=2492976 |doi=10.1503/cmaj.071131 |url=}}</ref> | ||
==== Supplemental iron: ==== | ==== Supplemental iron: ==== | ||
*[[Iron|Supplemental iron]] is recommended, as needed, to keep the [[transferrin]] saturation of above 20 percent and a [[serum]] [[ferritin]] level of above100 ng/mL. | *[[Iron|Supplemental iron]] is recommended, as needed, to keep the [[transferrin]] saturation of above 20 percent and a [[serum]] [[ferritin]] level of above100 ng/mL.<ref name="pmid15051778">{{cite journal |vauthors=Auerbach M, Ballard H, Trout JR, McIlwain M, Ackerman A, Bahrain H, Balan S, Barker L, Rana J |title=Intravenous iron optimizes the response to recombinant human erythropoietin in cancer patients with chemotherapy-related anemia: a multicenter, open-label, randomized trial |journal=J. Clin. Oncol. |volume=22 |issue=7 |pages=1301–7 |date=April 2004 |pmid=15051778 |doi=10.1200/JCO.2004.08.119 |url=}}</ref> | ||
==== Intravenous iron: ==== | ==== Intravenous iron: ==== | ||
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==== Erythropoietin: ==== | ==== Erythropoietin: ==== | ||
In case of patients who do not respond to [[oral]] or [[parenteral]] iron infusions [[erythropoietin]] should be considered. | In case of patients who do not respond to [[oral]] or [[parenteral]] iron infusions [[erythropoietin]] should be considered.<ref name="pmid8049455">{{cite journal |vauthors=Spivak JL |title=Recombinant human erythropoietin and the anemia of cancer |journal=Blood |volume=84 |issue=4 |pages=997–1004 |date=August 1994 |pmid=8049455 |doi= |url=}}</ref> | ||
*Stable patients can be administered synthetically prepared [[erythropoiesis]]-stimulating agent such as [[erythropoietin]]. | *Stable patients can be administered synthetically prepared [[erythropoiesis]]-stimulating agent such as [[erythropoietin]].<ref name="pmid11953880">{{cite journal |vauthors=Lind M, Vernon C, Cruickshank D, Wilkinson P, Littlewood T, Stuart N, Jenkinson C, Grey-Amante P, Doll H, Wild D |title=The level of haemoglobin in anaemic cancer patients correlates positively with quality of life |journal=Br. J. Cancer |volume=86 |issue=8 |pages=1243–9 |date=April 2002 |pmid=11953880 |pmc=2375336 |doi=10.1038/sj.bjc.6600247 |url=}}</ref> | ||
*[[Erythropoietin]] can be given once per week, while [[darbepoetin]] should be administered once every two or three weeks. | *[[Erythropoietin]] can be given once per week, while [[darbepoetin]] should be administered once every two or three weeks. | ||
*It is important to give [[oral]] [[iron]] supplementation to all the patients receiving [[erythropoietin]] or [[darbepoetin]], in order to maintain a t[[Transferrin|ransferrin]] [[saturation]] more than 20 percent and a [[serum]] [[ferritin]] more than 100 ng/mL. | *It is important to give [[oral]] [[iron]] supplementation to all the patients receiving [[erythropoietin]] or [[darbepoetin]], in order to maintain a t[[Transferrin|ransferrin]] [[saturation]] more than 20 percent and a [[serum]] [[ferritin]] more than 100 ng/mL. | ||
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==== Blood Transfusion: ==== | ==== Blood Transfusion: ==== | ||
*In case of severe [[disease]], [[blood transfusion]] is recommended. | *In case of severe [[disease]], [[blood transfusion]] is recommended. | ||
====Alternative Options==== | |||
*Recent studies a | |||
==== In majority of cases, treatment of the underlying disorder is more effective: ==== | ==== In majority of cases, treatment of the underlying disorder is more effective: ==== | ||
*If the case is underlying [[malignancy]], [[chemotherapy]] or [[radiotherapy]] may transiently exacerbate [[anemia]] due to [[Bone marrow suppression|mylesuppressive]] effects, however in the long term, it leads to improvement. | *If the case is underlying [[malignancy]], [[chemotherapy]] or [[radiotherapy]] may transiently exacerbate [[anemia]] due to [[Bone marrow suppression|mylesuppressive]] effects, however in the long term, it leads to improvement. | ||
*If the cause is [[Inflammatory|inflammatory disorder]], such as [[rheumatoid arthritis]] the management of the disease with a [[disease-modifying antirheumatic drug]] [[DMARD|(DMARD]]) improves the [[anemia]] significantly. | *If the cause is [[Inflammatory|inflammatory disorder]], such as [[rheumatoid arthritis]] the management of the disease with a [[disease-modifying antirheumatic drug]] [[DMARD|(DMARD]]) improves the [[anemia]] significantly.<ref name="pmid2589399">{{cite journal |vauthors=Cash JM, Sears DA |title=The anemia of chronic disease: spectrum of associated diseases in a series of unselected hospitalized patients |journal=Am. J. Med. |volume=87 |issue=6 |pages=638–44 |date=December 1989 |pmid=2589399 |doi= |url=}}</ref> | ||
*If the root cause of [[anemia]] is not found, a detailed search for [[Inflammatory|inflammatory disorders]] such as [[inflammatory bowel disease]] and [[malignancy]] should be carried. | *If the root cause of [[anemia]] is not found, a detailed search for [[Inflammatory|inflammatory disorders]] such as [[inflammatory bowel disease]] and [[malignancy]] should be carried. | ||
*It is recommended to start with age-appropriate health [[Screening (medicine)|screening]]. | *It is recommended to start with age-appropriate health [[Screening (medicine)|screening]]. | ||
Revision as of 21:54, 2 October 2018
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Medical Therapy
Supplemental iron:
- Supplemental iron is recommended, as needed, to keep the transferrin saturation of above 20 percent and a serum ferritin level of above100 ng/mL.[2]
Intravenous iron:
- Intravenous iron is more effective than oral supplementaion.
- Intestinal absorption of iron is greatly reduced due to hepcidin activity at intestinal lining.
- Hepcidin-induced entrapment of iron can be managed with parenteral iron infusions.
Erythropoietin:
In case of patients who do not respond to oral or parenteral iron infusions erythropoietin should be considered.[3]
- Stable patients can be administered synthetically prepared erythropoiesis-stimulating agent such as erythropoietin.[4]
- Erythropoietin can be given once per week, while darbepoetin should be administered once every two or three weeks.
- It is important to give oral iron supplementation to all the patients receiving erythropoietin or darbepoetin, in order to maintain a transferrin saturation more than 20 percent and a serum ferritin more than 100 ng/mL.
Blood Transfusion:
- In case of severe disease, blood transfusion is recommended.
Alternative Options
- Recent studies a
In majority of cases, treatment of the underlying disorder is more effective:
- If the case is underlying malignancy, chemotherapy or radiotherapy may transiently exacerbate anemia due to mylesuppressive effects, however in the long term, it leads to improvement.
- If the cause is inflammatory disorder, such as rheumatoid arthritis the management of the disease with a disease-modifying antirheumatic drug (DMARD) improves the anemia significantly.[5]
- If the root cause of anemia is not found, a detailed search for inflammatory disorders such as inflammatory bowel disease and malignancy should be carried.
- It is recommended to start with age-appropriate health screening.
References
- ↑ Zarychanski R, Houston DS (August 2008). "Anemia of chronic disease: a harmful disorder or an adaptive, beneficial response?". CMAJ. 179 (4): 333–7. doi:10.1503/cmaj.071131. PMC 2492976. PMID 18695181.
- ↑ Auerbach M, Ballard H, Trout JR, McIlwain M, Ackerman A, Bahrain H, Balan S, Barker L, Rana J (April 2004). "Intravenous iron optimizes the response to recombinant human erythropoietin in cancer patients with chemotherapy-related anemia: a multicenter, open-label, randomized trial". J. Clin. Oncol. 22 (7): 1301–7. doi:10.1200/JCO.2004.08.119. PMID 15051778.
- ↑ Spivak JL (August 1994). "Recombinant human erythropoietin and the anemia of cancer". Blood. 84 (4): 997–1004. PMID 8049455.
- ↑ Lind M, Vernon C, Cruickshank D, Wilkinson P, Littlewood T, Stuart N, Jenkinson C, Grey-Amante P, Doll H, Wild D (April 2002). "The level of haemoglobin in anaemic cancer patients correlates positively with quality of life". Br. J. Cancer. 86 (8): 1243–9. doi:10.1038/sj.bjc.6600247. PMC 2375336. PMID 11953880.
- ↑ Cash JM, Sears DA (December 1989). "The anemia of chronic disease: spectrum of associated diseases in a series of unselected hospitalized patients". Am. J. Med. 87 (6): 638–44. PMID 2589399.