eMedicine Specialties > Pediatrics: General Medicine > Hematology

Anemia, Chronic: Treatment & Medication

Author: Susumu Inoue, MD, Professor of Pediatrics and Human Development, Michigan State University College of Human Medicine; Clinical Professor of Pediatrics, Wayne State University School of Medicine; Director of Pediatric Hematology/Oncology, Associate Director of Pediatric Education, Department of Pediatrics, Hurley Medical Center
Coauthor(s): John T Truman, MD, MPH, Professor of Clinical Pediatrics, Columbia University; Deputy Chair, Department of Pediatrics, Section of Hematology-Oncology, Babies and Children's Hospital of New York; Margaret T Lee, MD, Assistant Professor, Department of Pediatrics, Division of Pediatric Hematology, Children's Hospital of New York, Columbia University
Contributor Information and Disclosures

Updated: Dec 8, 2008

Treatment

Medical Care

Chronic anemia merits prompt, if not immediate, attention.

Exclusion of impending high-output cardiac failure is the most important issue. High-output failure is the only reason that blood transfusion is necessary. RBC transfusions must be performed cautiously; rapid expansion of intravascular volume may cause congestive heart failure in a well-compensated patient. Two or more small aliquots of RBCs may need to be administered with a few hours of re-equilibration between transfusions. Elective surgery can usually be performed without preoperative transfusion as long as blood is available.

For patients who require long-term transfusional support, identification of a limited number of dedicated blood donors is appropriate. Donors are selected on the basis of detailed antigenic crossmatching with the patient in hopes of avoiding development of immune-mediated hemolysis. These patients ultimately develop iron overload and are likely to require iron-chelation therapy (see Thalassemia).

Common sense should prevail in recognizing that, although anemia may be quite profound, the patient is usually well. In this circumstance, it is prudent not to follow the hemoglobin level too closely and thereby create unnecessary apprehension in the family. When physiologic adaptive mechanisms are in place, most children do well, and what is abnormal in others becomes normal in these children. At this point, the art of medicine takes precedence over the science of medicine.

Surgical Care

Splenectomy is usually indicated in patients with hereditary spherocytosis (HS), unless the degree of hemolysis is very minor (reticulocyte count of 5% or less). Delay splenectomy until patients are aged 8-9 years, by which time immunity to encapsulated bacteria is well established. Typically, this is also before hemolysis sufficient to result in bilirubin gallstones has occurred. However, in some patients, repetitive splenic sequestration occurs necessitating earlier splenectomy.

Consultations

Many chronic anemias can be diagnosed and managed by generalists. However, when subtle distinctions in morphology or interpretation of laboratory data relative to hemolytic anemia are important, a pediatric hematologist is usually needed. Certainly, when bone marrow aspiration and biopsy are contemplated, the experience of a pediatric hematologist is essential. Unless readily explained by increased reticulocyte count or other physiological conditions, macrocytosis usually warrants consultation with a hematologist.

Medication

Refer to articles on each disease entity for treatment details. In many circumstances, such as congenital dyserythropoietic anemias, no specific treatment is available. Recombinant erythropoietin has been useful in managing anemia related to chronic renal failure, rheumatoid arthritis, and AIDS. Hemoglobin levels and a general feeling of well being are much improved in patients since recombinant erythropoietin became commercially available.

More on Anemia, Chronic

Overview: Anemia, Chronic
Differential Diagnoses & Workup: Anemia, Chronic
Treatment & Medication: Anemia, Chronic
Follow-up: Anemia, Chronic
Multimedia: Anemia, Chronic
References
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References

  1. Iolascon A, Camaschella C, Pospisilova D, Piscopo C, Tchernia G, Beaumont C. Natural history of recessive inheritance of DMT1 mutations. J Pediatr. Jan 2008;152(1):136-9. [Medline].

  2. Guillem F, Lawson S, Kannengiesser C, Westerman M, Beaumont C, Grandchamp B. Two nonsense mutations in the TMPRSS6 gene in a patient with microcytic anemia and iron deficiency. Blood. Sep 1 2008;112(5):2089-91. [Medline].

  3. Barth E, Malorgio C, Tamaro P. Allogeneic bone marrow transplantation in hematologic disorders of childhood: new trends and controversies. Haematologica. Nov 2000;85(11 Suppl):2-8. [Medline].

  4. Brill JR, Baumgardner DJ. Normocytic anemia. Am Fam Physician. Nov 15 2000;62(10):2255-64. [Medline].

  5. Carvalho NF, Kenney RD, Carrington PH, Hall DE. Severe nutritional deficiencies in toddlers resulting from health food milk alternatives. Pediatrics. Apr 2001;107(4):E46. [Medline].

  6. Croisille L, Tchernia G, Casadevall N. Autoimmune disorders of erythropoiesis. Curr Opin Hematol. Mar 2001;8(2):68-73. [Medline].

  7. Fitzsimons EJ, Brock JH. The anaemia of chronic disease. BMJ. Apr 7 2001;322(7290):811-2. [Medline].

  8. Giri N, Kang E, Tisdale JF, et al. Clinical and laboratory evidence for a trilineage haematopoietic defect in patients with refractory Diamond-Blackfan anaemia. Br J Haematol. Jan 2000;108(1):167-75. [Medline].

  9. Janka GE, Schneider EM. Modern management of children with haemophagocytic lymphohistiocytosis. Br J Haematol. Jan 2004;124(1):4-14. [Medline].

  10. Novitzky N. Myelodysplastic syndromes in children. A critical review of the clinical manifestations and management. Am J Hematol. Apr 2000;63(4):212-22. [Medline].

  11. Sherry B, Mei Z, Md RY. Continuation of the decline in prevalence of anemia in low-income infants and children in five states. Pediatrics. Apr 2001;107(4):677-82. [Medline].

  12. Yarali N, Duru F, Sipahi T, et al. Parvovirus B19 infection reminiscent of myelodysplastic syndrome in three children with chronic hemolytic anemia. Pediatr Hematol Oncol. Sep 2000;17(6):475-82. [Medline].

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Further Reading

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Keywords

primary chronic anemia, secondary chronic anemia, iron deficiency, hereditary spherocytosis, HS, sickle cell disease, thalassemia, chronic anemia, anemia, low hemoglobin levels, hemoglobinopathy, osteomyelitis, hookworm, heart failure, syncope, Diamond-Blackfan anemia, cholelithiasis, splenomegaly, constipation, hypothyroidism, chronic pyelonephritis, bacterial endocarditis, osteomyelitis, jaundice, gallstones, Fanconi anemia, thrombocytopenia, collagen vascular disease, hypersplenism, leukemia, myelofibrosis, myeloproliferative disorder, myelodysplastic syndrome, transient erythroblastopenia of childhood, TEC, Hodgkin disease, non-Hodgkin lymphomas, rhabdomyosarcoma, toxoplasmosis, rubella, cytomegalovirus infection, herpes simplex, hemolytic uremic syndrome, HUS, thrombotic thrombocytopenic purpura, TTP, pyruvate kinase deficiency, idiopathic pulmonary hemosiderosis, paroxysmal nocturnal hemoglobinuria, von Willebrand disease

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Contributor Information and Disclosures

Author

Susumu Inoue, MD, Professor of Pediatrics and Human Development, Michigan State University College of Human Medicine; Clinical Professor of Pediatrics, Wayne State University School of Medicine; Director of Pediatric Hematology/Oncology, Associate Director of Pediatric Education, Department of Pediatrics, Hurley Medical Center
Susumu Inoue, MD is a member of the following medical societies: American Academy of Pediatrics, American Society of Hematology, American Society of Pediatric Hematology/Oncology, International Society for Experimental Hematology, and Society for Pediatric Research
Disclosure: Nothing to disclose.

Coauthor(s)

John T Truman, MD, MPH, Professor of Clinical Pediatrics, Columbia University; Deputy Chair, Department of Pediatrics, Section of Hematology-Oncology, Babies and Children's Hospital of New York
John T Truman, MD, MPH is a member of the following medical societies: American Academy of Pediatrics, American Association for the History of Medicine, American Society of Pediatric Nephrology, and New York Academy of Medicine
Disclosure: Nothing to disclose.

Margaret T Lee, MD, Assistant Professor, Department of Pediatrics, Division of Pediatric Hematology, Children's Hospital of New York, Columbia University
Margaret T Lee, MD is a member of the following medical societies: American Society of Hematology
Disclosure: Nothing to disclose.

Medical Editor

J Martin Johnston, MD, Associate Professor of Pediatrics, Mercer University School of Medicine; Director of Pediatric Hematology/Oncology, Backus Children's Hospital; Consulting Oncologist/Hematologist, St Damien's Pediatric Hospital
J Martin Johnston, MD is a member of the following medical societies: American Society of Pediatric Hematology/Oncology
Disclosure: Nothing to disclose.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine
Disclosure: Pfizer Inc Stock Investment from broker recommendation; Avanir Pharma Stock Investment from broker recommendation

Managing Editor

Steven K Bergstrom, MD, Assistant to the Chairman, Department of Pediatrics, Division of Hematology-Oncology, Kaiser Permanente Medical Center of Oakland
Steven K Bergstrom, MD is a member of the following medical societies: Alpha Omega Alpha, American Society of Clinical Oncology, American Society of Hematology, American Society of Pediatric Hematology/Oncology, Children's Oncology Group, and International Society for Experimental Hematology
Disclosure: Nothing to disclose.

CME Editor

Samuel Gross, MD, Professor Emeritus, Department of Pediatrics, University of Florida, Clinical Professor, Department of Pediatrics, UNC, Adjunct Professor, Department of Pediatrics, Duke University
Samuel Gross, MD is a member of the following medical societies: American Association for Cancer Research, American Society for Blood and Marrow Transplantation, American Society of Clinical Oncology, American Society of Hematology, and Society for Pediatric Research
Disclosure: Nothing to disclose.

Chief Editor

Max J Coppes, MD, PhD, MBA, Executive Director, Center for Cancer and Blood Disorders, Children's National Medical Center; Professor of Medicine, Oncology, and Pediatrics, Georgetown University
Max J Coppes, MD, PhD, MBA is a member of the following medical societies: American Association for Cancer Research, American Society of Pediatric Hematology/Oncology, and Society for Pediatric Research
Disclosure: Nothing to disclose.

 
 
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