tailieunhanh - Chapter 058. Anemia and Polycythemia (Part 11)

Anemia: Treatment An overriding principle is to initiate treatment of mild to moderate anemia only when a specific diagnosis is made. Rarely, in the acute setting, anemia may be so severe that red cell transfusions are required before a specific diagnosis is made. Whether the anemia is of acute or gradual onset, the selection of the appropriate treatment is determined by the documented cause(s) of the anemia. Often, the cause of the anemia may be multifactorial. For example, a patient with severe rheumatoid arthritis who has been taking anti-inflammatory drugs may have a hypoproliferative anemia associated with chronic inflammation. | Chapter 058. Anemia and Polycythemia Part 11 Anemia Treatment An overriding principle is to initiate treatment of mild to moderate anemia only when a specific diagnosis is made. Rarely in the acute setting anemia may be so severe that red cell transfusions are required before a specific diagnosis is made. Whether the anemia is of acute or gradual onset the selection of the appropriate treatment is determined by the documented cause s of the anemia. Often the cause of the anemia may be multifactorial. For example a patient with severe rheumatoid arthritis who has been taking anti-inflammatory drugs may have a hypoproliferative anemia associated with chronic inflammation as well as chronic blood loss associated with intermittent gastrointestinal bleeding. In every circumstance it is important to evaluate the patient s iron status fully before and during the treatment of any anemia. Transfusion is discussed in Chap. 107 iron therapy is discussed in Chap. 98 treatment of megaloblastic anemia is discussed in Chap. 100 treatment of other entities is discussed in their respective chapters sickle cell anemia Chap. 99 hemolytic anemias Chap. 101 aplastic anemia and myelodysplasia Chap. 102 . Therapeutic options for the treatment of anemias have expanded dramatically during the past 25 years. Blood component therapy is available and safe. Recombinant EPO as an adjunct to anemia management has transformed the lives of patients with chronic renal failure on dialysis and made some improvements in the quality of life of anemic cancer patients receiving chemotherapy. Improvements in the management of sickle cell crises and sickle cell anemia have also taken place. Eventually patients with inherited disorders of globin synthesis or mutations in the globin gene such as sickle cell disease may benefit from the successful introduction of targeted genetic therapy Chap. 65 . Polycythemia Polycythemia is defined as an increase in circulating red blood cells above normal. This increase .