Treatment of anemia

By Dr Ananya Mandal, MD

Treating anemia entails treating the condition of low haemoglobin and red blood cells in blood as well as detecting and treating the disease process that has led to the anemia.

Unless the underlying cause of anemia, which may be continuous blood loss, haemolytic anemias, iron deficiency or increased demand states like pregnancy, are assessed and managed, the treatment remains incomplete.

Types of treatment for anemia

Treatment of anemia may depend on what type of anemia the patient has. (1-6)–

Iron deficiency anemia treatment

This usually involves taking iron supplements to replace the lack of intake of iron in diet or excess loss of iron.

The most commonly prescribed supplement is ferrous sulphate. It is taken as pills two or three times a day.

Oral iron preparations come with a host of side effects that include nausea, vomiting, abdominal pain, heartburn, constipation, diarrhea, black stool and blackening of teeth, gums and tongue.

Taking ferrous sulphate along with food or shortly after eating helps to reduce the side effects.

Another alternative is ferrous gluconate.

Iron can be replaced by taking diet rich in iron. This includes dark-green leafy vegetables, iron-fortified bread and cereal, beans, meat, nuts, apricots, prunes, raisins, dates etc.

Tea, coffee, calcium, found in dairy products such as milk, antacids etc. reduce the iron absorption from the gut and should be avoided.

Vitamin C supplements helps absorb iron better. Patient is checked up after two to four weeks to see if there is a response.

Vitamin B12 deficiency anaemia treatment

This can be treated by injections of vitamin B12. The vitamin is in the form of a substance known as hydroxocobalamine. The injections are given on alternate days for two weeks.

If there is a dietary lack of the vitamin, tablets may be prescribed. Vitamin B12 can be found in meat, milk, eggs, salmon etc.

Vegetarians or vegans may need supplementation as tablets or fortified cereals or soy products.

Anemia due to folate deficiency

For folate deficiency anemia daily folic acid tablets are prescribed.

Folate tablets are usually prescribed along with Vitamin B12 supplements. This is because folic acid treatment can sometimes improve the symptoms masking an underlying vitamin B12 deficiency.

If a vitamin B12 deficiency is not detected and treated at this stage there could be severe damage to the brain, nerves and spinal cord due to vitamin B12 deficiency.

Folate is found in broccoli, green cabbage, wheatgerm, pulses, nuts, green leafy vegetables etc.

Treatment for severe anemia

When the anaemia is more severe, a blood transfusion is often necessary.

Sickle cell anemia treatment

Patients with sickle cell anemia need a healthy diet, supplements of folic acid, vitamin D and zinc and avoid triggers for crises.

This includes smoking, alcohol, overexertion, dehydration, cold and hot temperatures, constricting clothes etc.

There is no cure for sickle cell anaemia, but the frequency and severity of crises and their complications can be reduced. They need complete vaccinations against flu, pneumococcus meningitis, Hepatitis B and other diseases to prevent infections.

Anemia due to infection

Anemia caused by an infection will usually improve when the infection is treated. This is especially true for newborns with severe infections called sepsis.

Treatment for an enlarged spleen

In some forms of haemolytic anemia there may be an enlarged spleen.

The spleen may be surgically removed to prevent RBCs from being removed from circulation or destroyed too rapidly.

Anemia in pregnancy

If the hemoglobin concentration is less than 9.0 g per dL anemia in pregnancy is diagnosed.
Anemia is managed with oral dose of 60 to 120 mg per day of iron. Patient is evaluated after four weeks of therapy.

Anemia and bone marrow treatment

Some medications are prescribed to stimulate the bone marrow to produce more RBCs. This is useful in aplastic anemia and leukemias.

Bone marrow transplantation may also be used. In this procedure, bone marrow cells taken from a matching donor (usually with a genetic match e.g. a sibling or blood relation).

This is then injected into the vein. This then travels through the bloodstream to the bone marrow and produced new blood cells.

Prevention of anemia

Prevention of anemia (4):

  • In infants and preschool children anemia can be prevented by encouraging exclusive breast feeding of infants (without supplementary liquids, water, formula or food) for four to six months after birth.

    During weaning from the breast to solids additional source of iron (approximately 1 mg per kg per day of iron) should be introduced in supplementary foods. If the infant is not breast fed, only an iron-fortified formula as a substitute for breast milk is recommended.

    In breast fed infants who have iron deficient diet 1 mg per kg per day of iron drops are recommended if not supplemented in other foods.

    Since milk hampers the absorption of iron from gut, it should be suggested that children aged one to five years need no more than 24 oz of cow's milk, goat's milk and soy milk per day.

    Foods rich in vitamin C (e.g., fruits, vegetables and juice) are recommended beyond six months to increase iron absorption.

  • For adolescent girls and women prevention of iron deficiency includes a healthy iron rich diet. All adolescent girls and nonpregnant women need to be screened for anemia every five to 10 years until menopause.
  • In pregnancy oral low-dose (30 mg per day) supplements of iron at the first prenatal visit may be started to prevent anemia. Pregnant women are encouraged to eat iron-rich foods and foods that enhance iron absorption.

Edited by April Cashin-Garbutt, BA Hons (Cantab)

Further Reading

What is Anemia?
Anemia Causes
Anemia Symptoms
Anemia Diagnosis

Sources

  1. http://www.nhs.uk/Conditions/Anaemia-iron-deficiency-/Pages/Treatment.aspx
  2. http://www.nhs.uk/Conditions/Anaemia-vitamin-B12-and-folate-deficiency/Pages/Treatment.aspx
  3. http://www.bbc.co.uk/health/physical_health/conditions/anaemia1.shtml
  4. http://www.aafp.org/afp/1998/1015/p1475.html
  5. http://kidshealth.org/parent/medical/heart/anemia.html#
  6. http://www.nhs.uk/Conditions/Sickle-cell-anaemia/Pages/Treatment.aspx
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