Anemia is a condition in which hemoglobin in the blood is reduced. This deficiency affects the oxygen transport function and leads to hypoxia, reduced oxygen supply to the tissues. This affects all processes in the body, the state of tissues, and the cellular mechanism. Without the presence of oxygen, chemical reactions do not take place, and energy exchange does not occur. Understanding the nature of anemia will help to determine the tactics of a treatment since different types of pathology have a different source of origin.
To determine whether anemia is linked to iron deficiency, a complete iron deficiency anemia screening should be conducted. It contains a biochemical blood test, an analysis of blood proteins that carry iron, and the ability of blood serum to bind a trace element (Auerbach & Adamson, 2016). It is necessary to take into account not only the number of erythrocytes and hemoglobin but also the color indicator, the size of erythrocytes, hematocrit, and other parameters.
The biochemical analysis helps to calculate the level of bilirubin and its fractions. Thus, this manipulation is required to clarify the type of anemia. The study of free protoporphyrin in erythrocytes determines the ability of erythrocytes to carry oxygen and allows determining the causes of anemia. The study of gastric acidity (pH meter) is also necessary for the diagnosis of IDA (Auerbach & Adamson, 2016). It is important to determine for what reason the absorption of iron is impaired. As a rule, there is no indication for red blood cell transfusion for patients with iron deficiency anemia. Moreover, even severe cases can be successfully treated with iron supplementation (Auerbach & Adamson, 2016). The risk of using this method outweighs all its benefits. Indications for transfusion may arise in patients with severe anemia in case of urgent surgical intervention.
CBC and a peripheral blood smear should be done to determine if anemia is associated with chronic kidney disease. The most common mechanism is hyperproliferation by decreasing erythropoietin production. Diagnosis of anemia caused by kidney disease is based on the indications of renal failure, normocytic anemia, and peripheral blood reticulocytopenia (Gafter-Gvili et al., 2019). Erythroid hypoplasia can be detected in the bone marrow, and fragmentation of erythrocytes in a peripheral blood smear indicates the presence of traumatic hemolysis.
As a rule, treatment includes maintenance therapy with erythropoietin and iron preparations. In patients undergoing long-term hemodialysis, therapy includes EPO at an initial dose of 50–100 IU/kg intravenously 3 times/week in combination with iron preparations (Gafter-Gvili et al., 2019). A maintenance dose of EPO may then be applied 1-3 times/week. Careful monitoring of response to treatment is required to avoid adverse effects associated with an increase in hemoglobin levels.
The practitioner should take into account several factors in prescribing treatment. In patients who do not react to therapy within 4-8 weeks, dose escalation of erythropoietin-stimulating agents cannot be recommended (Gafter-Gvili et al., 2019). In contrast, if there is no increase in Hb levels, ESA treatment should be discontinued (Gafter-Gvili et al., 2019). The physician should also recommend that the patient have regular tests for anemia. As kidney function decreases and in patients with more advanced CKD, the incidence and prevalence of anemia increases. In the absence of the use of erythropoiesis-stimulating agents, a progressive decrease in hemoglobin level may be observed, indicating the need for regular monitoring of its level.
Anemia is one of the complications of chronic renal failure, affecting the quality of life and overall state of patients. Only after the final diagnosis is made and the causes of anemia are identified, the doctor has to draw up an individual treatment regimen. The choice of treatment should be based on the severity of the iron deficiency, availability of venous access, response to previous therapy, and the presence of side effects with oral and intravenous therapy.
References
Auerbach, M., & Adamson, J. W. (2016). How we diagnose and treat iron deficiency anemia. American Journal of Hematology, 91(1), 31-38. Web.
Gafter-Gvili, A., Schechter, A., & Rozen-Zvi, B. (2019). Iron deficiency anemia in chronic kidney disease. Acta Haematologica, 142(1), 44-50. Web.