Anemia Management: Other

Abstract

Summary In a study involving 16 healthy volunteers Balestra et al demonstrated that breathing 100% oxygen at normal atmospheric pressure for 2 hours resulted in a significant increase in the subjects’ endogenous serum erythropoietin (EPO) levels at 24 and 36 hours after cessation of oxygen breathing.

Summary Anemia of chronic disease (ACD) is a hypoproliferative disorder that develops as a response to systemic illness or inflammation. Traditionally, it was thought to be an adverse consequence of systemic illness. However, Zarychanski and Houston believe that ACD is an adaptive response to an underlying disease state and support this argument in this article. Anemia in these circumstances is thought to be deleterious because the decrease in RBCs causes a decrease in oxygen-carrying capabilities and anemia is connected to a poor prognosis in many clinical disorders.

Summary Increased mortality associated with anemia has been reported in patients with stage 5 chronic kidney disease undergoing long-term dialysis treatment. An observational study showed that hemoglobin levels of 12-13 g/dL led to greater survival in patients on long-term hemodialysis (HD) compared with levels of >13 g/dL or < 11/5 g/dL.

Summary Erythropoiesis-stimulating agents (ESAs) and IV iron products have had a great impact on nephrology. RBC production is controlled by erythropoietin (EPO) and the hormone is produced de novo in the kidney in response to hypoxia. EPO replacement therapy became the mainstay of treatment for patients on dialysis who required many transfusions. Simultaneously, clinicians began to recognize the importance of iron supplementation in anemia management and a need for IV iron products was voiced.

Summary Patients with sickle cell disease (SCD) often have a delayed hemolytic transfusion reaction (DHTR), characterized by recurrence of disease complications, recipient RBC destruction, and no detectable antibody. The main cause is a conflict between transfused RBC antigens and recipient alloantibodies. In the search for mechanisms of DHTR, SCD may lead to phosphatidylserine (PS) exposure, which is a signal for suicidal RBC death (eryptosis), resulting in anemia, thrombogenesis, and endothelial adhesion with vaso-occlusive crisis (VOC).

Abstract

OBJECTIVE:

To evaluate chronic kidney disease (CKD)-associated anemia management challenges and limitations and discuss strategies to improve treatment rates and patient response to therapy, monitoring of patient response to therapy, and education of prescribing providers and patients.

DATA SOURCES:

Abstract

BACKGROUND:

Anemia is associated with higher morbidity and mortality in patients with heart failure (HF), but its implications for heath care costs are not well described.

METHODS AND RESULTS:

Abstract

BACKGROUND:

In consenting Jehovah's Witness patients and others for whom blood is contraindicated or not available, hemoglobin-based oxygen carrier (HBOC)-201 may enable survival in acutely anemic patients while underlying conditions are treated.

METHODS: