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Treatments for Anemia
Treatment list for Anemia:
The list of treatments mentioned in various sources for Anemia includes the following list. Always seek professional medical advice about any treatment or change in treatment plans.
- Iron supplements
- High-iron diet
- Healthy diet
- Intravenous iron - mainly for those on kidney dialysis
- Vitamin B12 supplements
- Folic acid supplements
- EPO injections - if anemia from an EPO deficiency
- Blood transfusions
- Copper - possibly used for related copper deficiency
- Iron
- Vitamin B6 - possibly used for related vitamin B6 deficiency
- Vitamin B12 - possibly used for related vitamin B12 deficiency
Treatments of Anemia: Online Medical Books
16 MEDICAL BOOKS ONLINE! Review excerpts from medical books online, free, without registration, for more information about the treatments of Anemia.
Fatigue:
Treatment
(In a Page: Signs and Symptoms)
- Treatment is targeted at specific underlying medical problems, if determined (e.g., thyroid disease, chronic infection, malignancy)
- Stop or change offending medications
- Consider trial of antidepressant therapy and/or cognitive behavioral psychiatric therapy
- Regularly scheduled physical activity
- Improve sleep hygiene
- Referral to support groups
- Discontinue offending medications
- Chronic fatigue syndrome and fibromyalgia are often treated with supportive care, healthy diet, moderate exercise, and low-dose antidepressants
- Weight loss for obesity
Anemia:
Treatment
(In a Page: Signs and Symptoms)
- Severe cases of anemia require immediate intervention if hemodynamic compromise occurs
- Administer supplemental O2 as needed
- In cases of ongoing acute blood loss, establish two large-bore IVs; monitor and send for blood type and cross
- IV fluids as necessary to maintain blood pressure
- Blood transfusion is generally indicated for Hb <8
–Young, healthy patients should only be transfused if symptomatic or have ongoing acute blood losses
–Cardiac patients may require transfusion at Hb <10
–Avoid transfusing beyond Hb >12, as this may increase blood viscosity and impair O2 delivery - Supplement vitamin B12, folate, and iron as necessary
- Patients with primary marrow disorders require transfusions, further evaluation, and possibly a bone marrow transplant
- Treat underlying disease according to established protocols
Low Back Pain/Swelling:
Treatment
(In a Page: Signs and Symptoms)
- In absence of red flag symptoms, return to activity as soon as possible; rest has not been shown to improve recovery
- Acetaminophen, NSAIDs, opioids, and/or muscle relaxants for pain; epidural corticosteroid injections may be indicated for resistant pain
- Patient education (weight loss, exercise, proper back biomechanics and ergonomics)
- Physical therapy, including pain relief modalities (ice, heat, ultrasound), stretching, strengthening, aerobic conditioning, and relaxation therapy
- Surgery may be indicated for refractory disease, large neurologic deficits, unbearable pain, or significant limitations
Fatigue:
Treatment
(In A Page: Pediatric Signs and Symptoms)
-
Behavioral modifications based on cause
–Increase duration of sleep
–Ensure three calorically adequate meals per day -
Correction of anemia
–Iron supplementation
–Blood transfusion if hemodynamically unstable -
Depression
–Psychological counseling and antidepressants -
Infectious mononucleosis
–Rest if fatigue is severe
–No contact sports with significant splenomegaly - Anti-inflammatory drugs for inflammatory causes
-
Chronic fatigue syndrome
–Emotional support
–Psychological treatment if indicated
–Modification of schedule as needed
–Various medications have been attempted, however no clear consensus, high rate of placebo effect
Pallor:
Treatment
(In A Page: Pediatric Signs and Symptoms)
- Immediate respiratory and cardiovascular stabilization
- Cardiovascular collapse or hypoglycemia should be treated appropriately
- Suspected sepsis or infection should be promptly treated with broad-spectrum antimicrobial therapy and supportive treatment
- Stress-dose steroid therapy if insufficiency suspected
-
Children with acute blood loss may not manifest anemia until the blood has had a chance to equilibrate
–Any suspected severe blood loss needs to be managed aggressively -
For children who are stable at presentation
–First ascertain whether pallor is true or relative
–Most pallor is due to anemia, so treatment should be directed at underlying cause of decreased hemoglobin production and concentration
Anemia:
Treatment
(In A Page: Pediatric Signs and Symptoms)
- Dependent upon etiology; if secondary, treat underlying cause or remove offending drug/agent
-
Iron deficiency
–Iron (6 mg/kg/day elemental iron) for 3 months
–Decrease milk and tannic acid intake
–Increase vitamin C intake (helps iron absorbtion)
–Response to therapy is diagnostic - Thalassemias, hemoglobinopathies, and membrane abnormalities: Referral to pediatric hematologist, may require chronic transfusions
-
Folic acid/vitamin B12 deficiency
–Identify cause (pernicious anemia, drugs, malnutrition, malabsorption, alcoholism, hemolysis, pregnancy)
–Provide repletion
–Treat B12 deficiency early to prevent neurologic damage
Pallor:
Emergency interventions
(Handbook of Signs & Symptoms (Third Edition))
If generalized pallor suddenly develops, quickly look for signs of shock, such as tachycardia, hypotension, oliguria, and a decreased level of consciousness (LOC). Prepare to rapidly infuse fluids or blood. Obtain a blood sample for hemoglobin and serum glucose levels and hematocrit. Keep emergency resuscitation equipment nearby.
Aplastic anemias:
Treatment
(Professional Guide to Diseases (Eighth Edition))
Effective treatment must eliminate any identifiable cause and provide vigorous supportive measures, such as packed RBC, platelet, and experimental histocompatibility locus antigen-matched leukocyte transfusions. Even after elimination of the cause, recovery can take months. Bone marrow transplantation is the treatment of choice for anemia due to severe aplasia and for patients who need constant RBC transfusions. (See Bone marrow transplantation.)
Patients with low leukocyte counts need special measures to prevent infection. The infection itself may require specific antibiotics; however, these aren’t given prophylactically because they tend to encourage resistant strains of organisms. Patients with low Hb levels may need respiratory support with oxygen in addition to blood transfusions.
For older patients, or for those who don’t have a matched bone marrow donor, antithymocyte globulin (ATG) is an alternative treatment. ATG is a horse serum that contains antibodies against human T cells. It may be used in an attempt to suppress the body’s immune system, allowing the bone marrow to resume its blood cell-generating function. Other immunosuppressant agents, such as cyclosporine, may also be used.
Other treatments may include corticosteroids to stimulate erythroid production, marrow-stimulating agents such as androgens (which remain controversial), and colony stimulation factors to encourage growth of specific cellular components.
Folic acid deficiency anemia:
Treatment
(Professional Guide to Diseases (Eighth Edition))
Treatment consists primarily of folic acid supplements and elimination of contributing causes. Folic acid supplements may be given orally or parenterally (to patients who are severely ill, have malabsorption, or are unable to take oral medication). Many patients respond favorably to a well-balanced diet. If the patient has combined B12 and folate deficiencies, folic acid replenishment alone may aggravate neurologic dysfunction.
Iron deficiency anemia:
Treatment
(Professional Guide to Diseases (Eighth Edition))
The first priority of treatment is to determine the underlying cause of anemia. Once this is determined, iron replacement therapy can begin. Treatment of choice is an oral preparation of iron or a combination of iron and ascorbic acid (which enhances iron absorption). However, in some cases, iron may have to be administered parenterally — for instance, if the patient is noncompliant to the oral preparation, if he needs more iron than he can take orally, if malabsorption prevents adequate iron absorption, or if a maximum rate of Hb regeneration is desired.
Because total dose I.V. infusion of supplemental iron is painless and requires fewer injections, it’s usually preferred to I.M. administration. Pregnant patients and geriatric patients with severe anemia, for example, should receive a total dose infusion of iron dextran in normal saline solution over 8 hours. To minimize the risk of an allergic reaction to iron, an I.V. test dose of 0.5 ml should be given first. For more patient care information, see Supportive management of patients with anemia, page 1034.
Pernicious anemia:
Treatment
(Professional Guide to Diseases (Eighth Edition))
Early parenteral vitamin B12 replacement can reverse pernicious anemia, minimize complications and, possibly, prevent permanent neurologic damage. An initial high dose of parenteral vitamin B12 causes rapid RBC regeneration. Within 2 weeks, Hb levels should rise to normal, and the patient’s condition should markedly improve. Because rapid cell regeneration increases the patient’s iron and folate requirements, concomitant iron and folic acid replacement is necessary to prevent iron deficiency anemia.
After the patient’s condition improves, the vitamin B12 dosage can be decreased to maintenance levels and given monthly. Because such injections must be continued for life, the patient should learn self-administration of vitamin B12.
If anemia causes extreme fatigue, the patient may require bed rest until Hb levels rise. If Hb levels are dangerously low, he may need blood transfusions. Digoxin, a diuretic, and a low-sodium diet may be necessary for a patient with heart failure. Most important is the replacement of vitamin B12 to control the condition that led to this failure. Antibiotics help combat accompanying infections.
Sickle cell anemia:
Treatment
(Professional Guide to Diseases (Eighth Edition))
Treatment begins before age 4 months with prophylactic penicillin. If the patient's Hb drops suddenly or if his condition deteriorates rapidly, he'll need to be hospitalized for a transfusion of packed RBCs. In a sequestration crisis, treatment may include sedation, administration of analgesics, a blood transfusion, oxygen administration, and large amounts of oral or I.V. fluids.
Daily folic acid supplementation is recommended to prevent megaloblastic crisis. Hydroxyurea, which causes an increase in the synthesis of fetal Hb and a significant reduction in crises, is being used for some patients with sickle cell anemia. Researchers have found it helpful for some patients because it reduces the frequency of painful crises and episodes of acute chest syndrome and decreases the need for blood transfusions.
Newer drugs are being developed to manage sickle cell anemia. Some of these agents try to induce the body to produce more fetal Hb, which helps decrease the amount of sickling. Others work by increasing the binding of oxygen to sickle cells. Currently, bone marrow transplantation offers the only cure for sickle cell anemia. Gene therapy (replacing HbS with normal HbA) may be the ideal treatment, but it's difficult to perform.
Sideroblastic anemias:
Treatment
(Professional Guide to Diseases (Eighth Edition))
Treatment of sideroblastic anemias depends on the underlying cause. The hereditary form usually responds to several weeks of treatment with high doses of pyridoxine (vitamin B6). The acquired secondary form generally subsides after the causative drug or toxin is removed, or the underlying condition is adequately treated. Folic acid supplements may also be beneficial when concomitant megaloblastic nuclear changes in RBC precursors are present. Elderly patients with sideroblastic anemia (usually the primary acquired form) are less likely to improve quickly and are more likely to develop serious complications. Deferoxamine may be used to treat chronic iron overload in selected patients.
Carefully crossmatched transfusions (providing needed Hb) or high doses of androgens are effective palliative measures for some patients with the primary acquired form of sideroblastic anemia. However, this form is essentially refractory to treatment and usually leads to death from acute leukemia or from respiratory or cardiac complications.
Some patients with sideroblastic anemia may benefit from phlebotomy to prevent hemochromatosis (the accumulation of iron in body tissues). Phlebotomy steps up the rate of erythropoiesis and uses up excess iron stores; thus, it reduces serum and total-body iron levels.
Chronic fatigue syndrome:
Treatment
(Professional Guide to Diseases (Eighth Edition))
No treatment is known to cure CFS. Symptomatic treatment may involve the use of medications to treat depression, anxiety, pain, discomfort, and fever. Hidden yeast infections may be present and should be treated. Antiviral drugs such as acyclovir and selected immunomodulating agents, such as I.V. gamma globulin, ampligen, and transfer factor, may be of assistance.
Fatigue:
Patient counseling
(Professional Guide to Signs & Symptoms (Fifth Edition))
Regardless of the cause of fatigue, you may need to help the patient alter his lifestyle to achieve a balanced diet, a program of regular exercise, and adequate rest. Counsel him about setting priorities, keeping a reasonable schedule, and developing good sleep habits. Teach stress management techniques as appropriate.
Pallor:
Emergency Interventions
(Professional Guide to Signs & Symptoms (Fifth Edition))
If generalized pallor suddenly develops, quickly look for signs of shock, such as tachycardia, hypotension, oliguria, and decreased level of consciousness. Prepare to rapidly infuse fluids or blood. Keep emergency resuscitation equipment nearby.
Low birth weight:
Emergency Interventions
(Professional Guide to Signs & Symptoms (Fifth Edition))
Because low birth weight may be associated with poorly developed body systems, particularly the respiratory system, your priority is to monitor the neonate’s respiratory status. Be alert for signs of distress, such as apnea, grunting respirations, intercostal or xiphoid retractions, or a respiratory rate exceeding 60 breaths/minute after the first hour of life. If you detect any of these signs, prepare to provide respiratory support. Endotracheal intubation or supplemental oxygen with an oxygen hood may be needed.
Monitor the neonate’s axillary temperature. Decreased fat reserves may keep him from maintaining normal body temperature, and a drop below 97.8° F (36.5° C) exacerbates respiratory distress by increasing oxygen consumption. To maintain normal body temperature, use an overbed warmer or an Isolette. (If these are unavailable, use a wrapped rubber bottle filled with warm water, but be careful to avoid hyperthermia.) Cover neonate’s head to prevent heat loss.
Aplastic and hypoplastic anemias:
Treatment
(Handbook of Diseases)
Identifiable causes must be eliminated and vigorous supportive measures must be provided, such as transfusions of packed RBCs and platelets. Human leukocyte antigen–matched leukocytes or antithymocyte globulin, used alone or in combination with cyclosporine, has especially impaired outcomes for children and severely neutropenic patients. Experimental trials of androgen therapy are in process. Even after elimination of the cause, recovery can take months. Bone marrow transplantation is the treatment of choice for patients with anemia resulting from severe aplasia and for patients who need constant RBC transfusions.
Preventing infection
Patients with low leukocyte counts need special measures to prevent infection. The infection itself may require specific antibiotics; however, they aren’t given prophylactically because they tend to encourage resistant strains of organisms. Patients with low hemoglobin (Hb) levels may need respiratory support with oxygen, in addition to blood transfusions.
Other treatments
Other appropriate treatments include a corticosteroid to stimulate erythroid production (tends to be successful in children but not adults); a marrow-stimulating agent, such as an androgen (which is controversial); an antilymphocyte globulin (which is experimental); an immunosuppressant (if the patient doesn’t respond to other therapy); and a colony-stimulating factor to encourage growth of specific cellular components.
Folic acid deficiency anemia:
Treatment
(Handbook of Diseases)
Folic acid supplements and the elimination of contributing causes are the primary treatments. Supplements may be given orally (usually 1 to 5 mg/day) or parenterally (to patients who are severely ill, have malabsorption, or are unable to take oral medication).
Clinical tip The clinical features of anemia usually disappear within 1 to 2 weeks after administration of folate.
Many patients also respond favorably to a well-balanced diet.
If the patient has combined vitamin B12 and folate deficiencies, folic acid replenishment alone may aggravate neurologic dysfunction.
Iron deficiency anemia:
Treatment
(Handbook of Diseases)
The first priority of treatment is to determine the underlying cause of anemia. When this is determined, iron replacement therapy can begin. The treatment of choice is an oral preparation of iron or a combination of iron and ascorbic acid (which enhances iron absorption). In some cases, iron may have to be administered parenterally — for example, if the patient is noncompliant to the oral preparation, if she needs more iron than she can take orally, if malabsorption prevents adequate iron absorption, or if a maximum rate of Hb regeneration is desired. (See Injecting iron solutions.)
Because a total-dose I.V. infusion of supplemental iron is painless and requires fewer injections, it’s usually preferred over I.M. administration. Pregnant patients and elderly patients with severe anemia, for example, should receive a total-dose infusion of iron dextran in normal saline solution over 8 hours. To minimize the risk of an allergic reaction to iron, an I.V. test dose of 0.5 ml should be given first.
Pernicious anemia:
Treatment
(Handbook of Diseases)
Early parenteral vitamin B12 replacement can reverse pernicious anemia, minimize complications, and possibly prevent permanent neurologic damage.
Vitamin B12 replacement
An initial high dose of parenteral vitamin B12 causes rapid RBC regeneration. Within 2 weeks, the Hb level should rise to normal, and the patient’s condition should markedly improve. Because rapid cell regeneration increases the patient’s iron and folate requirements, concomitant iron and folic acid replacement is necessary to prevent iron deficiency anemia.
After the patient’s condition improves, the vitamin B12 dosage can be decreased to maintenance levels and given monthly. Because such injections must be continued for life, patients should learn how to do the injections themselves.
Other measures
If anemia causes extreme fatigue, the patient may require bed rest until his Hb level rises. If his Hb level is dangerously low, blood transfusions, digoxin, a diuretic, and a low-sodium diet for heart failure may be needed. Most important is the replacement of vitamin B12 to control the condition that led to this failure. Antibiotics help combat accompanying infections.
Sickle cell anemia:
Treatment
(Handbook of Diseases)
Prophylactic antibiotics are given in certain treatments and at follow-up, even when the patient isn’t in crisis. If the patient’s Hb drops suddenly or if his condition deteriorates rapidly, a transfusion of packed RBCs is needed. Supplementation with folic acid is required because of rapid RBC turnover.
In a sequestration crisis, treatment may include sedation, administration of analgesics, blood transfusion, oxygen administration, and large amounts of oral and I.V. fluids. A good antisickling agent isn’t available yet; the most commonly used drug, sodium cyanate, has many adverse effects.
Partial exchange transfusions may be done in crisis situations. Bone marrow transplants are also successful in treatment.
Sideroblastic anemias:
Treatment
(Handbook of Diseases)
The underlying cause determines the type of treatment.
Hereditary form
Hereditary sideroblastic anemia usually responds to several weeks of treatment with high doses of pyridoxine (vitamin B6).
Primary acquired form
Elderly patients with sideroblastic anemia — most commonly the primary acquired form — are less likely to improve quickly and are more likely to develop serious complications. Deferoxamine may be used to treat chronic iron overload in selected patients.
Carefully cross-matched transfusions (providing needed Hb) or high doses of androgens are effective palliative measures for some patients with the primary acquired form of sideroblastic anemia. However, this form is essentially refractory to treatment and usually leads to death from acute leukemia or from respiratory or cardiac complications.
CLINICAL TIP: Some patients with sideroblastic anemia may benefit from phlebotomy to prevent hemochromatosis. Phlebotomy steps up the rate of erythropoiesis and uses up excess iron stores; thus, it reduces serum and total-body iron levels.
Secondary acquired form
The secondary acquired form generally subsides after the causative drug or toxin is removed or the underlying condition is adequately treated. Folic acid supplements may also be beneficial when concomitant megaloblastic nuclear changes in RBC precursors are present.
Chronic fatigue and immune dysfunction syndrome:
Treatment
(Handbook of Diseases)
Treatment is aimed at the cause, if one can be found. Supportive therapy includes an anti-inflammatory, an antihistamine, and rest.
Treatment of symptoms may include a tricyclic antidepressant (doxepin), a histamine2-blocker (cimetidine), and an anxiolytic (alprazolam). In some patients, avoidance of environmental irritants and certain foods may help to relieve symptoms.
Experimental treatments include the antiviral acyclovir and selected immunomodulators, such as I.V. gamma globulin, ampligen, and transfer factor.
Pallor:
Nursing considerations
(Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series)
If the patient has chronic generalized pallor, prepare him for blood studies and, possibly, bone marrow biopsy. If he has localized pallor, he may require arteriography or other diagnostic studies to accurately determine the cause.
When pallor results from low cardiac output, administer blood and fluids. The patient may also require a diuretic, a cardiotonic, and an antiarrhythmic. Frequently monitor his vital signs, intake and output, electrocardiogram results, and hemodynamic status.
Patient teaching
If the patient’s pallor is related to anemia, explain the importance of an iron-rich diet and rest. If he has pallor due to frostbite or Raynaud’s disease, inform him about cold protection measures. If pallor is related to orthostatic hypotension, explain the need to stand up slowly and to sit down when dizziness occurs.
Fatigue:
Patient counseling
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
Regardless of the cause of fatigue, you may need to help the patient alter his lifestyle to achieve a balanced diet, a program of regular exercise, and adequate rest. Counsel him about setting priorities, keeping a reasonable schedule, and developing good sleep habits. Teach stress management techniques as appropriate.
Pallor:
Emergency Actions
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
If generalized pallor suddenly develops, quickly look for signs of shock, such as tachycardia, hypotension, oliguria, and decreased level of consciousness. Prepare to rapidly infuse fluids or blood. Keep emergency resuscitation equipment nearby.
Fatigue:
Nursing considerations
(Nursing: Interpreting Signs and Symptoms)
▪ Help the patient determine which daily activities he may need help with and how he should pace himself to ensure sufficient rest.
▪ Take measures to reduce pain and nausea.
▪ If fatigue results from a psychogenic cause, refer him for psychological counseling.
Patient teaching
▪ Educate the patient about lifestyle modifications, including diet and exercise.
▪ Stress the importance of pacing activities and planning rest periods.
▪ Discuss stress management techniques.
Pallor:
Nursing considerations
(Nursing: Interpreting Signs and Symptoms)
▪ If the patient has chronic generalized pallor, prepare him for blood studies and, possibly, bone marrow biopsy.
▪ If the patient has localizedpallor, he may require arteriography or other diagnostic studies to accurately determine the cause.
▪ When pallor results from low cardiac output, administer blood and fluids as well as a diuretic, a cardiotonic, and an antiarrhythmic as needed.
▪ Monitor the patient's vital signs, intake and output, electrocardiogram results, and hemodynamic status.
Patient teaching
▪ Teach the patient about diagnostic tests and procedures.
▪ Explain the disorder and treatment plan.
Low birth weight:
Nursing considerations
(Nursing: Interpreting Signs and Symptoms)
▪ Initiate feedings as soon as possible and continue to feed the neonate every 2 to 3 hours.
▪ Provide gavage or I.V. nutrition for the sick or very premature neonate.
▪ Check abdominal girth daily or more frequently if indicated, and check stools for blood to detect necrotizing enterocolitis.
▪ Prepare for a sepsis workup if signs of infection are associated with low birth weight.
▪ Check the neonate's vital signs every 15 minutes for the first hour and at least once every hour thereafter until his condition stabilizes.
▪ Be alert for changes in temperature or behavior, feeding problems, respiratory distress, or periods of apnea—possible indications of infection.
▪ Monitor blood glucose levels and watch for signs and symptoms of hypoglycemia, such as irritability, jitteriness, tremors, seizures, irregular respirations, lethargy, and a high-pitched or weak cry.
▪ If the neonate is receiving supplemental oxygen, carefully monitor arterial blood gas values and the oxygen concentration of inspired air to prevent retinopathy.
▪ Monitor the neonate's urine output by weighing diapers before and after voiding.
▪ Check urine color, measure specific gravity, and test for the presence of glucose, blood, or protein.
▪ Watch for changes in the neonate's skin color because increasing jaundice may indicate hyperbilirubinemia.
Patient teaching
▪ Explain disorder and all procedures and treatments to the parents.
▪ Encourage the parents to participate in their neonate's care to strengthen bonding.
Medications used to treat Anemia:
Note:You must always seek professional medical advice about any treatment or change in treatment plans.
Some of the different medications used in the treatment of Anemia include:
- Darbepoetin alfa - mainly used in anemia associated with chronic renal failure and chemotherapy
- Aranesp - mainly used in anemia associated with chronic renal failure and chemotherapy
- Epoetin alfa
- Epogen
- Procrit
- Eprex
- Epomax
- Oxymetholone
- Anadrol
Unlabelled alternative drug treatments include:
- Methylprednisolone
- A-Methapred
- Depmedalone-40
- Depmedalone-80
- Depo-Medrol
- Enpak Refill
- Mar-Pred 40
- Medrol
- Medrol Acne Lotion
- Medrol Enpak
- Medrol Veriderm Cream
- Meprolone
- Neo-Medrol Acne Lotion
- Neo-Medrol Veriderm
- Rep-Pred 80
- Solu-Medrol
Medical news summaries about treatments for Anemia:
The following medical news items are relevant to treatment of Anemia:
- About Blackfan Diamond anemia
- Operation options for obesity
- Ovarian cancer diagnosed in woman a decade after a hysterectomy
- Short term use of AST to treat prostate cancer provides survival benefits without significant impact of side effects
- Single use anemia test available free of cost to people at risk of chronic kidney disease
- Symptoms of old age may be similar to many other treatable conditions
- Treatment options are available for excessive menstrual bleeding
- Warnings highlight possible risk associated with anemia drug
Discussion of treatments for Anemia:
Anemia in Kidney Disease and Dialysis: NIDDK (Excerpt)
If no other
cause for EPO deficiency is found, it can be treated with a
genetically engineered form of the hormone, which is usually
injected under the skin two or three times a week. Hemodialysis
patients who can't tolerate EPO shots may receive the hormone
intravenously during treatment, but this method requires a larger,
more expensive dose and may not be as effective. DOQI recommends
that patients treated with EPO therapy should achieve a target Hgb
of 11 to 12 g/dL.
Iron
Many people with kidney
disease need both EPO and iron supplements to raise their Hct to a
satisfactory level. If your iron levels are too low, then EPO won't
help and you'll continue to experience the effects of anemia. You
may be able to take an iron pill, but many studies show that iron
pills don't work as well in people with kidney failure as iron given
intravenously. Iron is injected directly into an arm or into the
tube that returns blood to your body during hemodialysis.
A
nurse or doctor will give you a test dose because a very small
number of people (less than 1 percent) have a bad reaction to iron
injections. If you begin to wheeze or have trouble breathing, your
health care provider can administer epinephrine or corticosteroids
to counter the reaction. Even though the risk is small, you'll be
asked to sign a form stating that you understand the possible
reaction and that you agree to have the treatment. Talk with your
health care provider if you have any questions.
In addition
to measuring your Hct and Hgb, your tests will also include two
measurements to show whether you have enough iron.
- Your ferritin level indicates the amount of iron stored in your body. According to DOQI guidelines, your ferritin score should be no less than 100 micrograms per liter (mcg/L) and no more than 800 mcg/L.
- TSAT stands for transferrin saturation, a score that indicates how much iron is available to make red blood cells. DOQI guidelines call for a TSAT score between 20 percent and 50 percent.
Anemia in Kidney Disease and Dialysis: NIDDK (Excerpt)
In addition to EPO and iron, a few people may also need vitamin B12 and folic acid supplements. (Source: excerpt from Anemia in Kidney Disease and Dialysis: NIDDK)
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