8/17/2019 The Purpose of Establishing the Etiology of an Anemia is to Permit Selection of a Specific and Effective Therapy

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The purpose of establishing the etiology of an anemia is to permit selection of a specific and effective therapy. Forexample, corticosteroids are useful in the treatment of autoimmune hemolytic anemia.

Therapy and medical care vary considerably in the group of hereditary disorders. Splenectomy has beenadvantageous 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.

Drugs and chemicals capable of producing aplasia or a maturation arrest of erythroid precursors should bediscontinued or avoided. Similarly, diseases known to be associated with anemia should be appropriatelytreated. uidelines for the treatment of chemotherapy!associated anemia are available.

Surgery is useful to control bleeding in patients who are anemic. "ost commonly, bleeding is from the I tract,uterus, or bladder. #atients should be hemodynamically stable before and during surgery. $ blood transfusion may beneeded.

Management of beta-thalassemia major and major hemoglobinopathies

#atients with beta!thalassemia ma%or and the ma%or hemoglobinopathies associated with sickle hemoglobin &'b(usually re)uire medical attention at fre)uent intervals for the treatment of anemia, infection, pain, and leg ulcersbecause of the serious nature of these illnesses. *onversely, many of the other hereditary abnormalities haveminimal or no clinical manifestations+ the patient re)uires only reassurance.

Consultations

Surgical consultation is indicated to control bleeding, for splenectomy when necessary, and for biopsies to establishthe presence of neoplasia. *onsultation with gastroenterologists is fre)uently sought to identify a bleeding site in thegut. rologic consultation may be needed to investigate hematuria.

Follow-up

#atients with chronic anemia can usually be cared for on an outpatient basis. Follow!up care is necessary to ensurethat therapy is being continued and to assess the efficacy of treatment.

Transfusion

Transfusion of packed red blood cells &-*s( should be reserved for patients who are actively bleeding and forpatients with a severe and symptomatic anemia./012Transfusion is palliative and should not be used as a substitute forspecific therapy. In chronic diseases associated with anemia of chronic disorders, erythropoietin may be helpful inaverting or reducing transfusions of packed -*s.

'emolytic transfusion reactions and transmission of infectious disease are risks of blood product transfusions.#atients with autoimmune antibodies against -*s are at greater risk of a hemolytic transfusion reaction because ofdifficulty in cross!matching the blood. 3ccasionally, the blood of patients with autoimmune hemolytic anemia cannotbe cross!matched in vitro. In these cases, the patients re)uire in vivo cross!matching, in which incompatible blood istransfused slowly and periodic determinations are made to ensure that the patient is not developing hemoglobinemia.This method should be used only in patients with either significant hypoxia from the anemia or evidence of coronaryinsufficiency.

Iron Supplementation

The appropriate treatment of anemia due to blood loss is correction of the underlying condition and oraladministration of ferrous sulfate until the anemia is corrected and for several months afterward to ensure that bodystores are replete with iron. -elatively few indications exist for the use of parenteral iron therapy, and bloodtransfusions should be reserved for the treatment of shock or hypoxia.

 $lthough the traditional dosage of ferrous sulfate is 415 mg &65 mg of elemental iron( orally three times a day, lowerdoses &eg, 05!17 mg of elemental iron daily( may be as effective and cause fewer side effects. To promoteabsorption, patients should avoid tea and coffee and may take vitamin * &577 units( with the iron pill once daily. Ifferrous sulfate has unacceptable side effects, ferrous gluconate, 415 mg daily &45 mg of elemental iron( is a possiblealternative for patients who cannot tolerate ferrous sulfate./042

 $ study in Iran demonstrated that once!weekly, low!dose iron supplementation can be effective in improving ironstatus and in treating iron deficiency anemia./082"o9affari!:hosravi et al randomly selected and assigned 0;4adolescent girls aged 08!06 years to receive either 057 mg ferrous sulfate once weekly for 06 weeks or no ironsupplementation. efore and after intervention, the percentage of anemia, iron deficiency anemia, and iron deficiencywere measured in both groups of girls.

8/17/2019 The Purpose of Establishing the Etiology of an Anemia is to Permit Selection of a Specific and Effective Therapy

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8/17/2019 The Purpose of Establishing the Etiology of an Anemia is to Permit Selection of a Specific and Effective Therapy

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If patients are being transferred for diagnostic reasons, transferring them before transfusion is helpful. If thetransfusion is necessary before transfer to achieve hematopoietic stability, consult with the receiving physician todetermine laboratory tests that should be performed before transfusion. #atients who are hemodynamically unstableshould not be transported.