eMedicine Specialties > Pediatrics: General Medicine > Hematology
Anemia, Chronic: Treatment & Medication
Updated: Dec 8, 2008
- Overview
- Differential Diagnoses & Workup
- Treatment & Medication
- Follow-up
- Multimedia
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.
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| Overview: Anemia, Chronic |
| Differential Diagnoses & Workup: Anemia, Chronic |
Treatment & Medication: Anemia, Chronic |
| Follow-up: Anemia, Chronic |
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References
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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].
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].
Brill JR, Baumgardner DJ. Normocytic anemia. Am Fam Physician. Nov 15 2000;62(10):2255-64. [Medline].
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].
Croisille L, Tchernia G, Casadevall N. Autoimmune disorders of erythropoiesis. Curr Opin Hematol. Mar 2001;8(2):68-73. [Medline].
Fitzsimons EJ, Brock JH. The anaemia of chronic disease. BMJ. Apr 7 2001;322(7290):811-2. [Medline].
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].
Janka GE, Schneider EM. Modern management of children with haemophagocytic lymphohistiocytosis. Br J Haematol. Jan 2004;124(1):4-14. [Medline].
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].
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].
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].
Further Reading
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
Treatment & Medication: Anemia, Chronic