eMedicine Specialties > Hematology > Red Blood Cells and Disorders

Anemia: Treatment & Medication

Author: Marcel E Conrad, MD, (Retired) Distinguished Professor of Medicine, University of South Alabama
Contributor Information and Disclosures

Updated: Mar 11, 2008

Treatment

Medical Care

The purpose of establishing the etiology of an anemia is to permit selection of a specific and effective therapy.

• Transfusion of packed RBCs should be reserved for patients who are actively bleeding and for patients with a severe and symptomatic anemia.⁷ Transfusion is palliative and should not be used as a substitute for specific therapy. In chronic diseases associated with anemia of chronic disorders, erythropoietin may be helpful in averting or reducing transfusions of packed RBCs.
• The appropriate treatment of anemia due to blood loss is correction of the underlying condition and oral administration of ferrous sulfate until the anemia is corrected and for several months afterward to ensure that body stores are replete with iron. Relatively few indications exist for the use of parenteral iron therapy, and blood transfusions should be reserved for the treatment of shock or hypoxia.
• Nutritional therapy is used to treat deficiency of iron, vitamin B-12, and folic acid. Pyridoxine may be useful in the treatment of certain patients with sideroblastic anemia, even though this is not a deficiency disorder.
• Corticosteroids are useful in the treatment of autoimmune hemolytic anemia.
• Treatment of aplastic disorders includes removal of the offending agent whenever it can be identified, supportive therapy for the anemia and thrombocytopenia, and prompt treatment of infection. Avoid transfusion in patients with a potential bone marrow donor because transfusion worsens the probability of cure from transplantation. Certain patients seem to develop a salutary response with immunosuppressive therapy (ie, antithymocyte globulin, cyclosporin). Splenectomy may provide sufficient improvement for patients with hypoplastic, but not totally aplastic, marrow so that transfusion is not necessary, and platelet and granulocyte counts increase to less dangerous levels (see Surgical Care).
• Therapy and medical care vary considerably in the group of hereditary disorders. Splenectomy has been advantageous in hereditary spherocytosis and hereditary elliptocytosis, in some of the unstable hemoglobinopathies, and in certain patients with pyruvic kinase deficiency. It has little value in most other hereditary hemolytic disorders (see Surgical Care).
• Patients with beta-thalassemia major and the major hemoglobinopathies associated with sickle Hb usually require medical attention at frequent intervals for the treatment of anemia, infection, pain, and leg ulcers because of the serious nature of these illnesses. Conversely, many of the other hereditary abnormalities have minimal or no clinical manifestations; the patient only requires reassurance.
• Drugs and chemicals capable of producing aplasia or a maturation arrest of erythroid precursors should be discontinued and avoided. Similarly, diseases known to be associated with anemia should be appropriately treated.
• Guidelines related to the treatment of chemotherapy-associated anemia and CME related to these guidelines are available.

Surgical Care

• Surgery is useful to control bleeding in patients who are anemic. Most commonly, bleeding is from the gastrointestinal tract, the uterus, or the bladder. Patients should be hemodynamically stable before and during surgery. A blood transfusion may be needed.
• Splenectomy is useful in the treatment of autoimmune hemolytic anemias and in certain hereditary hemolytic disorders (ie, hereditary spherocytosis and elliptocytosis, certain unstable Hb disorders, pyruvic kinase deficiency). Improvement in survival rates has been reported in patients with aplastic anemia, but splenectomy is not the preferential therapy. Leg ulcers have shown improvement in some patients with thalassemia. Prior to splenectomy, patients should be immunized with polyvalent pneumococcal vaccine. Preferably, this should be administered more than 1 week prior to surgery.
• Bone marrow and stem cell transplantation have been used in patients with leukemia, lymphoma, Hodgkin disease, multiple myeloma, myelofibrosis, and aplastic disease. Survival rates improved, and hematologic abnormalities were corrected. Allogeneic bone marrow transplantation successfully corrected phenotypic expression of sickle cell disease and thalassemia and provided enhanced survival in patients who survive transplantation.

Consultations

• Surgical consultation is indicated to control bleeding, for splenectomy when necessary, and for biopsies to establish the presence of neoplasia.
• Consultation with gastroenterologists is frequently sought to identify a bleeding site in the gut.
• Urologic consultation may be needed to investigate hematuria.

Diet

• Iron deficiency anemia is prevalent in geographic locations where little meat is in the diet. Many of these locations have sufficient dietary inorganic iron to equal the iron content in persons residing in countries in which meat is eaten. However, heme iron is more efficiently absorbed than inorganic food iron.
• A strict vegetarian diet requires iron and vitamin B-12 supplementation.
• Folic acid deficiency occurs among people who consume few leafy vegetables.
• Coexistence of iron and folic acid deficiency is common among Third World nations.

Activity

• The activity of patients with severe anemia should be curtailed until the anemia is partially corrected. Transfusion can often be avoided by ordering bed rest, while therapy is initiated for a patient with correctable anemia (eg, pernicious anemia).
• March hemoglobinuria is a rare hemolytic disorder usually observed in young males. Individuals develop hemoglobinuria after marching or running on hard surfaces. Curtailing the precipitating exercise (ie, running on grass rather than concrete) and using shoes with reinforced soles are helpful in preventing hemoglobinuria.

Medication

Documentation of the etiology of anemia is essential in the selection of therapy. All microcytic anemias are not caused by iron deficiency; some are iron-overloading disorders. Similarly, all megaloblastic anemias are not associated with either vitamin B-12 deficiency or folic acid deficiency. Hereditary hemolytic disorders do not improve with corticosteroid therapy. Specific therapy for anemia is discussed in articles describing the different causes of anemia (see Differential Diagnoses).

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