Is anaemia treatable
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Treatability of Anaemia: Insights from Recent Research
Anaemia in Diabetes: Treatment Considerations
Anaemia is prevalent among patients with diabetes, especially those with nephropathy or renal impairment. It significantly increases the risk of diabetic complications such as nephropathy, retinopathy, and macrovascular disease. The primary cause is often the kidney's failure to produce sufficient erythropoietin in response to low haemoglobin levels. While correcting anaemia in diabetic patients is theoretically beneficial, the actual impact on patient outcomes remains uncertain. The TREAT trial aims to clarify the benefits and risks of anaemia correction in this population1.
Severe Anaemia in High HIV Prevalence Areas
In regions with high HIV prevalence, such as southern Africa, severe anaemia is common among hospitalized adults. Traditional treatments focusing on iron deficiency, worms, and malaria are often ineffective for HIV-positive patients. Instead, these patients frequently suffer from tuberculosis and bacterial infections, which require targeted treatments. Therefore, managing severe anaemia in these settings should include investigations for tuberculosis and the use of appropriate antibiotics, alongside iron supplements2.
Immunosuppressive Therapy for Severe Aplastic Anaemia
Severe aplastic anaemia (AA) can be effectively treated with immunosuppressive therapy (IST) or hematopoietic stem cell transplantation. IST, particularly when combined with the thrombopoietin receptor agonist eltrombopag, has shown significant improvements in patient outcomes. However, relapse remains a challenge, necessitating further optimization of treatment protocols to enhance long-term results3.
Anaemia Management in Palliative Care
Anaemia is a common issue in palliative care patients, contributing to significant symptom burden. Current evidence supports a patient-centered approach to investigating and managing anaemia, focusing on correcting reversible causes and adopting a restrictive approach to blood transfusions. Routine use of oral iron and erythropoiesis-stimulating agents (ESAs) is not recommended, and the effectiveness of intravenous (IV) iron in this patient group requires further research4.
Preoperative Anaemia in Orthopaedic Surgery
Undiagnosed anaemia is frequent in elective orthopaedic surgical patients and is linked to higher risks of blood transfusion and perioperative complications. Guidelines recommend early detection and treatment of anaemia, including addressing nutritional deficiencies and using ESAs when necessary. Proper management of anaemia in this context can significantly improve patient outcomes5.
Natural Antioxidants in Anaemia Treatment
Traditional treatments for anaemia, such as blood transfusions and oral iron supplements, often come with side effects and absorption issues. Natural antioxidants and plant extracts offer a promising alternative, providing therapeutic benefits with fewer side effects. These natural treatments can be used as primary, alternative, or adjunct therapies for various types of anaemia6.
Iron Repletion in Iron Deficiency Anaemia
Iron deficiency anaemia (IDA) is the most common and treatable form of anaemia. The treatment landscape is shifting towards the use of IV iron due to its effectiveness and improved formulations that reduce adverse effects. IV iron is also beneficial for conditions beyond IDA, such as heart failure and fatigue, highlighting its broad therapeutic potential7.
Anaemia Post-Critical Care
Anaemia is prevalent among survivors of critical illness, affecting their quality of life. Treating anaemia with IV iron has shown potential benefits in non-critically ill patients, but its efficacy in critical care survivors needs further investigation. The INTACT trial aims to assess the feasibility of a larger study to determine the benefits of IV iron in this population8.
Anaemia of Chronic Disease
Anaemia of chronic disease (ACD) is common among hospitalized patients with chronic inflammatory disorders. Treatment involves addressing the underlying disease, using transfusions for rapid haemoglobin correction, and administering recombinant erythropoietin for prolonged therapy. However, iron supplementation should be avoided due to its potential to promote pathogen growth and inhibit immune responses9.
Anaemia in Pregnancy
Anaemia during pregnancy, often due to iron deficiency, is a significant issue, particularly in low-resource settings. A treatment protocol developed for antenatal care on the Myanmar-Thailand border showed high compliance and effectiveness in reducing anaemia at delivery. Early antenatal care attendance and prompt treatment initiation are crucial for managing anaemia in pregnancy10.
Conclusion
Anaemia is a treatable condition with various effective management strategies depending on the underlying cause and patient population. From diabetes and HIV-related anaemia to severe aplastic anaemia and anaemia in pregnancy, tailored treatments and early interventions are key to improving patient outcomes. Further research and optimization of treatment protocols are essential to address the challenges and enhance the efficacy of anaemia management across different settings.
Sources and full results
Most relevant research papers on this topic
Anaemia in diabetes: is there a rationale to TREAT?
TREAT is a randomized controlled trial aimed at determining the optimal approach to managing anaemia in diabetes patients, with the goal of reducing cardiovascular events and improving outcomes.
Observational Study
Rigorous Journal
Highly CitedTreatable factors associated with severe anaemia in adults admitted to medical wards in Blantyre, Malawi, an area of high HIV seroprevalence.
In high HIV prevalence areas, conventional treatment for severe anaemia in adults should include investigation for tuberculosis and antibiotics against enterobacteria, rather than iron deficiency.
Observational StudyImmunosuppressive therapy in severe aplastic anemia.
Adding eltrombopag to immunosuppressive therapy improves response rates and complete recovery in severe aplastic anemia patients, but further optimization is needed to prevent relapses and decrease clonal evolution rates.
Practice review: Evidence-based and effective management of anaemia in palliative care patients
Early investigation and targeted management of anaemia in advanced palliative care patients should focus on symptom relief and patient preferences, with a restrictive approach to blood transfusion.
Systematic ReviewDetection, evaluation, and management of preoperative anaemia in the elective orthopaedic surgical patient: NATA guidelines
Preoperative anaemia management in orthopaedic surgery patients should include a haemoglobin determination 28 days before surgery, treatment of nutritional deficiencies, and erythropoiesis-stimulating agents.
Systematic ReviewHighly CitedNatural Antioxidants in Anemia Treatment
Natural antioxidants, such as vitamin C and vitamin E, show potential in treating various types of anemia, offering a natural alternative to traditional treatments and reducing side effects.
Literature ReviewThe role of iron repletion in adult iron deficiency anemia and other diseases
Intravenous iron supplementation is effective for treating iron deficiency anemia and has potential applications in treating heart failure, restless leg syndrome, fatigue, and prevention of acute mountain sickness.
Rigorous JournalHighly CitedINtravenous iron to treat anaemia following CriTical care (INTACT): A protocol for a feasibility randomised controlled trial
Intravenous iron treatment may improve quality of life and recovery in survivors of critical illness, but further investigation is needed before a multicentre trial.
RCTPathogenesis and treatment of anaemia of chronic disease.
Anaemia of chronic disease (ACD) is a common condition in chronic inflammatory disorders, and its treatment involves addressing the underlying disease and using transfusions and recombinant erythropoietin.
Highly CitedEvaluation of a treatment protocol for anaemia in pregnancy nested in routine antenatal care in a limited-resource setting
The developed anaemia treatment protocol in antenatal care in a low-resource setting showed high compliance, but human error and fluctuation in haematocrit levels around 30% delayed treatment initiation.
Observational Study