How I treat anemia with red blood cell transfusion and iron

被引:9
作者
Carson, Jeffrey L. [1 ,4 ]
Brittenham, Gary M. [2 ,3 ]
机构
[1] Rutgers Robert Wood Johnson Med Sch, Dept Med, New Brunswick, NJ USA
[2] Columbia Univ, Vagelos Coll Phys & Surg, Dept Pediat, New York, NY USA
[3] Columbia Univ, Vagelos Coll Phys & Surg, Dept Med, New York, NY USA
[4] Rutgers Robert Wood Johnson Med Sch, Dept Med, 125 Paterson St, New Brunswick, NJ 08901 USA
基金
美国国家卫生研究院;
关键词
ACUTE MYOCARDIAL-INFARCTION; RESTRICTIVE TRANSFUSION; HEART-FAILURE; MYELODYSPLASTIC SYNDROMES; INTRAVENOUS IRON; DEFICIENCY; THRESHOLDS; TRIAL; REQUIREMENTS; STRATEGIES;
D O I
10.1182/blood.2022018521
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Severe anemia is commonly treated with red blood cell transfusion. Clinical trials have demonstrated that a restrictive transfusion strategy of 7 to 8 g/dL is as safe as a liberal transfusion strategy of 9 to 10 g/dL in many clinical settings. Evidence is lacking for subgroups of patients, including those with preexisting coronary artery disease, acute myocardial infarction, congestive heart failure, and myelodysplastic neoplasms. We present 3 clinical vignettes that highlight the clinical challenges in caring for patients with coronary artery disease with gastrointestinal bleeding, congestive heart failure, or myelodysplastic neoplasms. We emphasize that transfusion practice should be guided by patient symptoms and preferences in conjunction with the patient's hemoglobin concentration. Along with the transfusion decision, evaluation and management of the etiology of the anemia is essential. Iron-restricted erythro-poiesis is a common cause of anemia severe enough to be considered for red blood cell transfusion but diagnosis and management of absolute iron deficiency anemia, the anemia of inflammation with functional iron deficiency, or their combination may be problematic. Intravenous iron therapy is generally the treatment of choice for absolute iron deficiency in patients with complex medical disorders, with or without coexisting functional iron deficiency.
引用
收藏
页码:777 / 785
页数:9
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