The goal of anemia treatment is to improve erythropoiesis, increase hemoglobin concentration, and intervene in the primary underlying cause. The main objectives include alleviating symptoms such as fatigue and dizziness, and preventing complications like cardiac overload. Treatment methods vary depending on the type of anemia (such as iron deficiency, vitamin B12 deficiency, or anemia related to chronic disease), and may include medication, nutritional supplementation, or surgical intervention.
Treatment strategies are typically divided into "causative treatment" and "symptomatic support." For example, iron deficiency anemia requires iron supplementation, while aplastic anemia may require bone marrow transplantation. Regular monitoring of blood cell counts and liver and kidney function is crucial for evaluating treatment efficacy.
Oral iron supplements such as ferrous sulfate can be absorbed through the intestines to promote hemoglobin synthesis; injectable iron preparations (such as sucrose iron) directly replenish iron stores and are suitable for patients with malabsorption. Erythropoiesis-stimulating agents (ESAs) can stimulate bone marrow hematopoiesis and are commonly used in patients with renal anemia.
Vitamin B12 and folic acid treatments are used for megaloblastic anemia and can repair DNA synthesis defects. In severe anemia cases, blood transfusion can rapidly increase hemoglobin levels, but attention must be paid to blood compatibility and infection risks.
Mainly applicable to patients with hemoglobin levels below normal (adult males <13 g/dL, females <12 g/dL) and confirmed etiology through blood tests. Examples include:
Other hematologic diseases such as leukemia or myeloma should be ruled out to avoid misdiagnosis.
Oral iron supplements are usually taken 2-3 times daily, after meals to reduce gastrointestinal irritation. Dosage is adjusted based on age and severity of anemia (e.g., 100-200 mg of elemental iron daily for adults). Injectable iron must be administered at medical facilities, with single doses calculated according to the degree of iron deficiency (e.g., sucrose iron 100-1000 mg weekly).
ESAs (such as epoetin alfa) are administered via subcutaneous or intravenous injection. Initial doses for renal anemia patients are typically 20,000-40,000 units weekly, adjusted based on hematologic response. Vitamin B12 supplementation can be given via intramuscular injection or high-dose oral intake.
Iron therapy can increase hemoglobin levels to normal within weeks, improving fatigue and activity tolerance. ESAs can reduce dependence on transfusions in chronic kidney disease patients and lower infection risks.
Common side effects of iron supplements include constipation, diarrhea, and staining of teeth. Overuse may lead to iron overload, damaging the liver and heart. Erythropoiesis-stimulating agents may increase the risk of thrombosis; if hematocrit (HCT) becomes too high, dosage should be reduced.
Severe allergic reactions: About 1-2% of patients may develop allergies to iron or EPO, with symptoms such as difficulty breathing or urticaria. Overdose of folic acid and vitamin B12 may induce neurological abnormalities or hypertension.
Contraindications include: iron overload diseases (such as hemochromatosis), undiagnosed hemolytic anemia, and hypersensitivity to treatment components. Pregnant women using EPO should evaluate fetal risks, and pediatric doses should be adjusted based on weight.
During treatment, monitoring of iron indices (such as ferritin, transferrin saturation) and liver and kidney function is necessary to avoid iron overload or drug accumulation toxicity.
Antacids may interfere with iron absorption and should be taken at least 2 hours apart. Non-steroidal anti-inflammatory drugs (NSAIDs) may exacerbate gastrointestinal side effects. Blood pressure should be monitored during EPO therapy due to potential interactions with antihypertensive medications.
Patients on anticoagulants should have dosage adjustments, as transfusions may introduce platelet antibodies affecting subsequent matching. Chemotherapy patients using EPO should evaluate the risk of excessive hematopoiesis.
Systematic reviews show that regular iron therapy can raise hemoglobin by 2-3 g/dL within 2-3 months. EPO reduces the number of transfusions in renal failure patients by 60-70% annually, but iron reserve monitoring is necessary to enhance efficacy.
Vitamin B12 therapy has a high response rate of up to 90% in megaloblastic anemia, but causes such as folate deficiency should be excluded. Genetic testing can assist in targeted treatment, such as avoiding certain antimalarial drugs in G6PD deficiency to prevent hemolysis.
Patients intolerant to oral iron can switch to injectable iron or specialized nutritional supplements containing fiber. Chronic anemia may consider using TPO receptor agonists (such as romiplostim) to stimulate platelet and red blood cell production.
In severe anemia where medication is not feasible, autologous bone marrow stem cell transplantation or gene therapy may be experimental options. Traditional Chinese medicine adjunct therapies such as blood tonifying formulas can be combined with Western medicine, but interactions with herbs and iron supplements should be avoided.
It is recommended to take iron supplements after meals and include vitamin C-rich foods (such as oranges and tomatoes) to enhance absorption. If nausea or diarrhea persists, try mixing the medication with fruit juice or adjusting the dose and frequency as advised by your doctor. Avoid taking with coffee, tea, or dairy products, as they can impair absorption.
Q: How to determine if herbal medicine for anemia suits my constitution in traditional Chinese medicine?TCM practitioners assess based on tongue and pulse diagnosis and symptoms (such as dizziness, palpitations, or cold limbs). For example, blood deficiency anemia may use Angelica sinensis and Rehmannia glutinosa, while spleen and stomach deficiency cold may require citrus peel and amomum. Always inform your doctor of allergies and current medications before treatment.
Q: Which foods should be avoided when consuming iron-rich foods?High phytate foods like whole grains (whole wheat, oats) and high-fiber vegetables (spinach, kale) can inhibit iron absorption; it is recommended to consume them 2-3 hours apart from iron-rich foods. Tannic acid in tea and coffee should also be avoided with iron-containing foods, and consumed at least 1 hour after meals.
Q: What precautions should be taken after a blood transfusion regarding daily activities?Avoid strenuous exercise or heavy lifting within 24 hours after transfusion to prevent bleeding at the vascular access site. Keep injection sites dry for 4-6 hours and monitor for allergic reactions such as fever or chills. Drink plenty of water to promote hemoglobin metabolism, but avoid alcohol and spicy foods.
Q: When should treatment be adjusted if anemia persists long-term?If hemoglobin levels do not increase by more than 10% after 3 months of regular treatment, or symptoms such as fatigue and dizziness do not improve, consult your doctor about combining erythropoietin injections or investigating underlying causes (such as chronic bleeding or metabolic abnormalities). Multidisciplinary evaluation involving hematology and gastroenterology may be necessary.
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