Friday, August 12, 2011

Treatment of the anemia of chronic disorder

The anemia observed in ACD is frequently mild, and correction may not always be necessary. There are, however, several reasons for attempting to correct the anemia present. First, anemia may be deleterious in itself, with effects on the cardiovascular system needed to maintain tissue oxygen supply. Second, anemia may be associated with a poorer prognosis in many chronic disease states, although whether anemia plays a causative role in determining prognosis is open to debate. Third, treatment may improve the quality of life for patients living with chronic conditions.

Treatment of the underlying inflammatory or malignant process associated with ACD will often result in improvement in the degree of anemia, examples being the use of corticosteroids in polymyalgia rheumatica, the use of TNF-alpha inhibitors in rheumatoid arthritis or inflammatory bowel disease, and the use of antiretroviral drugs in HIV infection. Indeed the severity of the anaemia will frequently mirror the activity of the chronic condition causing it, for example in rheumatoid arthritis. However, treatment of the underlying condition may not always be possible, for example in patients with incurable cancers or cardiac failure and alternative strategies may be necessary. Correction of as many contributory factors as possible is also desirable, for example correction of nutritional deficiencies.

Blood transfusion

Blood transfusion is widely available in the developed world and is a simple means of treating patients with moderate to severe anaemia, but blood remains a precious and expensive resource, and transfusion therapy carries long-term risks of viral transmission, iron overload and alloimmunization. Transfusion should therefore be reserved for patients with severe or life-threatening anaemia in the context of ACD, and is not an appropriate treatment for patients with this form of chronic anaemia.

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