Anemia symptoms, causes and treatments

There’s more to chronic kidney disease than you think. If your kidneys are not working properly, they may not be able to help your body make the red blood cells it needs. Anemia is a common side effect of kidney disease.

What causes anemia?

Anemia happens when there are not enough healthy red blood cells in your body. Red blood cells carry oxygen through your bloodstream, giving you energy and helping your muscles, bones, and organs work properly. Anemia can make you feel weak and tired because you are not getting the energy you need.

Normal

The oxygen that we breathe in passes through our lungs and into the red blood cells.

Anemia

In anemia, there are not enough red blood cells to carry this oxygen around the body.

How does chronic kidney disease (CKD) cause anemia?

Anybody can develop anemia, but it is very common in people with CKD. People with CKD may start to have anemia in the early stages of CKD, but it is most common in stages 3-5. Anemia usually gets worse as CKD gets worse. If your kidneys are not working as well as they should, you are more likely to get anemia.

If you think you might have CKD, talk to your doctor about getting tested. Management of anemia and its symptoms may help you feel better.

Anemia in CKD is more common if you:

Have diabetes

Have heart disease

Have high blood pressure

Are African-American

Are older than 75 years

What are the symptoms of anemia?

Anemia can happen with or without symptoms. Many of the symptoms of anemia can also be caused by other problems.  The only way be sure if you have anemia is to get tested. If you are experiencing symptoms, it is important that you talk to your doctor.

Dizziness, loss of concentration

Feeling dizzy or having difficulty concentrating may be a sign that your brain is not getting enough oxygen.

Pale skin

Paleness is caused by reduced blood flow or a lower number of red blood cells.

Chest pain

Anemia in CKD can increase your risk of heart problems because the heart has to work harder to provide blood to your body. If you experience an unusually fast heart rate or are worried about your heart health, please speak to your doctor.

Shortness of breath

Your blood may not have enough red blood cells to deliver oxygen to your muscles. By increasing your breathing rate, your body is trying to bring more oxygen into your body.

Fatigue or weakness

Easy fatigue, loss of energy, and reduced physical capacity

Cold intolerance

Sensitivity to the cold may mean there is not enough oxygen being delivered in the blood to your body

Anemia Risk Identifier Quiz

Take our quick anemia quiz to find out what your risk level is and to learn more about the symptoms of anemia.

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What type of anemia is common in people with CKD?

There are two main causes of anemia in CKD:

Less erythropoietin (EPO) than normal

All of the cells in your body live for a certain amount of time and then die. Your body is always working to make new cells to replace the ones that have died. Red blood cells live for about 115 days. Your kidneys help your body make red blood cells.

Healthy kidneys make a hormone called erythropoietin (EPO). EPO sends a signal to the body to make more red blood cells. If your kidneys are not working as well as they should, they can’t make enough EPO. Without enough EPO, your body doesn’t know to make enough red blood cells. This means fewer red blood cells are available for carrying oxygen through your body, leading to anemia.

Less iron than normal 

Iron is a mineral found in many foods, such as meats and leafy greens. Your body uses iron to make red blood cells. A common cause of anemia in people with CKD is iron deficiency. Iron deficiency means you do not have enough iron in your body. It can be caused by not getting enough iron in your diet or by losing blood, either through blood tests or during dialysis. If you don’t take in enough iron through your diet, you can get anemia. Around half of people with CKD stages 2 to 5 have some kind of iron deficiency.

Other types of anemia

Anemia caused by having too little EPO or too little iron in your body are the most common in people with CKD. However, there are also other types of anemia. Talk to your doctor to learn more.

Causes of iron deficiency

Not eating enough foods that are rich in iron

Iron from your food is not being absorbed properly into your bloodstream

Frequent blood donation or testing may increase demand for iron

Blood loss from dialysis

How will I know if I have anemia?

Talk to your doctor if you think you may have anemia. The only way to know if you have anemia is to have a blood test. When you have kidney disease, your doctor will want you to have blood tests often. These tests are used to check not only your kidney function, but also for signs of any other problems, such as the number of red blood cells and how much iron you have in your body.

The test for anemia is a simple blood test to check for the amount of hemoglobin in your blood. Hemoglobin is a part of your red blood cells. Figuring out the amount of hemoglobin you have in your blood can tell your doctor how many red blood cells you have.

Your doctor may also ask you if you’ve noticed any symptoms, such as changes in skin color or feeling unusually tired.

How is anemia treated?

Getting your anemia treated can help you feel better. Depending on the cause of your anemia, your doctor may recommend one of the following treatments:

• Erythropoiesis-stimulating agents (ESAs)  — ESAs are injectable medicines that work by sending a signal to the your body to make more red blood cells.
• Iron supplementation  — Your doctor may give you iron supplements as pills or as a shot. If you are on dialysis, you may be given an iron supplement during your dialysis treatment.
• Red blood cell transfusion  — A red blood cell transfusion is a procedure to increase the number of red blood cells in your body by giving you red blood cells from someone else’s body through an IV. This can temporarily improve your anemia symptoms.

Doctors and researchers are working on potential new treatments for anemia. New treatments in development are tested in clinical trials. If you’re interested in joining a clinical trial to try an investigational new treatment for anemia, visit ClinicalTrials.gov to learn about all available clinical trials for anemia.

If you have CKD, getting early treatment for your anemia can help slow the progress of your CKD. If you think you might have anemia, talk to your doctor about getting tested.

Anemia and end-stage renal disease (ESRD)

Anemia and end-stage renal disease (ESRD), also known as kidney failure, often go hand in hand. Most people with kidney failure who are on dialysis have anemia. Kidney transplant patients are also at higher risk for anemia. Learn more.

Talk with your doctor about anemia

Talk with your doctor or another member of your health care team to find out more about your anemia symptoms and treatment options. Our Talk to Your Doctor Guide can help you get the conversation started.

Watch: Video resources on anemia and kidney disease

• Symptoms of anemia
  

  When your body does not have enough oxygen due to anemia, you can feel drained or exhausted, both physically and mentally. It can be hard to distinguish symptoms, so we’ve put together a helpful guide.

  Up Next: Getting your questions answered about anemia

• Getting your questions answered about anemia
  

  If you have chronic kidney disease, it’s important to talk to your doctor or health care team about anemia. “Here are some questions to help you get the conversation started”

  Up Next: Complications of anemia and kidney disease

• Complications of anemia and kidney disease
  

  Managing your anemia of chronic kidney disease, also known as CKD, can boost your physical health, and your quality of life. However, anemia of CKD can affect how your body functions, and how you move around.

  Up Next: Anemia and kidney disease

• Webinar

  Anemia and kidney disease
  

  Dr. Jay Wish, a nephrologist and anemia expert, discusses why anemia happens in kidney disease patients, the symptoms, and what you and your healthcare team can do to manage the condition.

Common questions about anemia in kidney disease

How are patients with kidney disease and anemia treated?

Iron supplements, erythropoiesis-stimulating agents (ESAs) and red blood cell transfusions are current treatment options for anemia in chronic kidney disease (CKD). Doctors and researchers are working on potential new treatments for anemia that can be administered orally (by mouth) and may provide another option for treatment.

Can kidney disease cause anemia?

Anemia is more common in people with chronic kidney disease (CKD) and it can be caused by your CKD. Anemia happens when there are not enough red blood cells in your body. When your kidneys are not working like they should, your body may produce fewer red blood cells. Also, people with anemia and chronic kidney disease have lower levels of iron which is also used to make red blood cells. Fewer red blood cells means less oxygen is carried to your organs and tissues.  Learn more.

What type of anemia is associated with chronic kidney disease?

There are several kinds of anemia. The most common types of anemia in people with chronic kidney disease (CKD) are anemia caused by having too little of a hormone called erythropoietin (EPO) and anemia caused by having too little iron in your body. Learn more.

Is anemia a sign of kidney disease?

No, having anemia does not always mean you have kidney disease. However, anemia is a common complication of kidney disease. Anemia happens when there are not enough red blood cells in your body. If your kidneys are not working properly, they may not be able to help your body make the red blood cells it needs. Learn more.

Does anemia cause kidney disease?

No, anemia does not cause kidney disease. Anemia is a complication of CKD. People with CKD may start to have anemia in the early stages of CKD, though it is most common in people with stages 3-5 CKD. Anemia usually gets worse as your kidney function gets worse. 

Can low iron affect kidneys?

People with anemia and chronic kidney disease (CKD) may have lower levels of iron which is used to make red blood cells. This can be caused by not getting enough iron in your diet or by losing blood, either through blood tests or during dialysis. Fewer red blood cells means less oxygen is carried to your organs and tissues. Learn more.

What are some of the signs and symptoms of anemia in chronic kidney disease patients?

Anemia can happen with or without symptoms. Many of the symptoms of anemia can also be caused by other problems. The only way be sure if you have anemia is to get tested by your doctor. Signs or symptoms of anemia include:

• Dizziness
• Loss of concentration
• Pale skin
• Chest pain
• Shortness of breath
• Fatigue or weakness
• Sensitivity to cold

Learn more about the symptoms of anemia.

Are there foods you can eat to help with anemia when you have chronic kidney disease?

If your body does not have enough iron, a dietitian or health care professional may recommend you add more foods with iron to your diet. Foods high in iron include: shellfish, spinach, red meat, beans and broccoli. However, some of these foods may be high in other nutrients, like sodium, phosphorus, or potassium, which people with chronic kidney disease (CKD) may need to limit. Talk with your health care team before making changes to your diet. Learn more about eating healthy with kidney disease.

Anemia and Chronic Kidney Disease

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What is anemia?
Anemia happens when your red blood cells are in short supply. Red blood cells carry oxygen from your lungs to all parts of your body, giving you the energy you need for your daily activities.

What are the symptoms of anemia?
Anemia can cause you to:

• Look pale
• Feel tired
• Have little energy for your daily activities
• Have a poor appetite
• Have trouble sleeping
• Have trouble thinking clearly
• Feel dizzy or have headaches
• Have a rapid heartbeat
• Feel short of breath
• Feel depressed or “down in the dumps”

Why do people with kidney disease get anemia?
Your kidneys make an important hormone called erythropoietin (EPO). Hormones are chemical messengers that travel to tissues and organs to help you stay healthy. EPO tells your body to make red blood cells. When you have kidney disease, your kidneys cannot make enough EPO. Low EPO levels cause your red blood cell count to drop and anemia to develop.

Most people with kidney disease will develop anemia. Anemia can happen early in the course of kidney disease and grow worse as kidneys fail and can no longer make EPO. Anemia is especially common if you:

• Have diabetes
• Are African-American/Black
• Have moderate or severe loss of kidney function (CKD stage 3 or 4)
• Have kidney failure (stage 5)
• Are female

How do I know if I have anemia?
Not everyone with anemia has symptoms. If you have kidney disease, you should have a blood test to measure your hemoglobin level at least once a year to check for anemia. Hemoglobin is the part of red blood cells that carries oxygen throughout your body. If your hemoglobin is too low, it is likely you have anemia. In that case, your healthcare provider will check to find the exact cause of your anemia and plan a treatment that is right for you.

How do you treat anemia?
Your treatment will depend on the exact cause of your anemia.
If your anemia is due to kidney disease, your healthcare provider will treat you with:

• Drugs called erythropoiesis stimulating agents (ESAs)
  ESAs help your body make red blood cells. Your healthcare provider will give the ESA to you as an injection under the skin.
• Extra iron
  Your body also needs iron to make red blood cells—especially when you are receiving ESAs. Without enough iron, your ESA treatment will not work as well. Your healthcare provider may give you iron to take as a pill. Another way to receive iron is directly into a vein in your doctor’s office or clinic.

For more information please view our full PDF brochures or request a free copy by calling 855.NKF.CARES (855.653.2273) or email [email protected].

• Iron Needs in Dialysis

If you would like more information, please contact us.

© 2015 National Kidney Foundation. All rights reserved. This material does not constitute medical advice. It is intended for informational purposes only. Please consult a physician for specific treatment recommendations.

Anemia and Iron Needs in Dialysis

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prognosis, treatment, symptoms in the international clinic Medica24

Anemia is a common accompanying symptom of oncological diseases. In another way, it is called anemia. Its cause is a decrease in the level of hemoglobin in the blood. This is a protein found in red blood cells (erythrocytes) and is responsible for oxygen transport and oxygen supply to tissues. It also takes away carbon dioxide, which is formed in the process of metabolism.

Transfusion of blood and blood substitutes for cancer patients

Without oxygen, metabolism is impossible, and hence life itself. A decrease in hemoglobin leads to oxygen starvation, which is manifested by weakness, high fatigue, dizziness, and headache. Other signs of anemia are pallor, rapid pulse, shortness of breath, tinnitus, swelling, and chest pain. Separate symptoms indicate a deficiency of vitamin B12 and iron.

Anemia, oxygen starvation weakens the body and worsens the prognosis of cancer treatment. On the one hand, anemia depresses the human immune system, does not allow it to fight cancer cells in full force.

On the other hand, low hemoglobin reduces the effectiveness of chemotherapy drugs, as well as radiation therapy, which has been proven by clinical studies. The general weakness of the body limits the possibilities of surgical treatment. That is why the treatment of anemia, increasing the level of hemoglobin is one of the primary tasks in oncological diseases.

Especially often a decrease in hemoglobin occurs with cancer of the kidney, lung, ovary, uterus, bladder, with lymphomas, myelomas.

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Causes

Low hemoglobin levels can be associated with both the oncological disease itself and its treatment.

1. Chemotherapy with cytotoxic drugs destroys rapidly dividing cells in the body, not only cancer cells, but also bone marrow cells. They are responsible for the process of erythropoiesis – the formation of red blood cells (erythrocytes). The production of red blood cells decreases, their volume in the blood (hematocrit) decreases, and anemia develops.

   Chemotherapy with platinum drugs inhibits the functioning of the kidneys and their production of the hormone erythropoietin. This hormone stimulates the process of erythropoiesis – the formation of red blood cells. Its level decreases, erythropoiesis slows down, hematocrit decreases, and anemia develops.

   Radiation therapy can negatively affect the bone marrow, which also leads to a decrease in the production of red blood cells.

2. Many types of cancer metastasize to the bone, which affects the red bone marrow. Cancer cells replace normal, active bone marrow cells, resulting in a decrease in red blood cell production.
3. Anemia is associated with internal bleeding. For example, with cancer of the intestines, stomach. Constant blood loss causes a decrease in the volume of red blood cells and the development of oxygen starvation.
4. Functional disorders of the gastrointestinal tract and / or poor appetite lead to a deficiency of vitamin B12, iron, necessary for normal hematopoiesis and maintaining hemoglobin levels in the blood.
5. A malignant tumor has a toxic effect on the body. Cancer intoxication leads to damage and destruction of red blood cells – pathological hemolysis. In addition, intoxication negatively affects the functioning of the bone marrow, which leads to impaired erythropoiesis.
6. A person’s own immune system, reacting to a malignant tumor, can provoke a decrease in hemoglobin. Its active cells, cytokines, inhibit the production of erythropoietin by the kidneys. In addition, cytokines attack red blood cells – erythrocytes, reducing their life expectancy by one and a half to two times. This leads to a decrease in hematocrit and the development of anemia.

Often a combination of these factors is the cause of low hemoglobin and anemia in cancer.

Treatment

It is easy to detect low hemoglobin levels and diagnose anemia. For this, a general blood test is sufficient. It is much more difficult to establish the cause or reasons why this is happening in order to prescribe the appropriate treatment.

The normal hemoglobin level is 135-160 g per liter of blood in men and 120-140 g per liter of blood in women. At its level below 100 g / l, moderate anemia is diagnosed, below 80 g / l – severe, below 65 g / l – severe.

To find out the reason for the decrease in hemoglobin level, a biochemical blood test, iron, vitamin B12 tests are performed. Computed tomography and scintigraphy help to detect metastases in the bone marrow. If it is necessary to obtain an exhaustive picture, endoscopic and other instrumental and laboratory examinations are performed.

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RBC transfusion

There are many ways to increase hemoglobin. First of all, to influence the cause of anemia. But such treatment can be lengthy, and the margin of time is limited. For example, it may be necessary to quickly increase the level of hemoglobin in order to prepare the patient for surgery.

Therefore, in some cases, a decision is made about a symptomatic increase in hemoglobin. The fastest and most effective way is red blood cell transfusion. To do this, donor blood is processed in a centrifuge, the content of erythrocytes in it rises, and it is transfused to the patient.

Red blood cell transfusion is used not only in preparation for surgery, but also as part of chemotherapy premedication. This method is used in severe forms of anemia, when you need to quickly raise the level of hemoglobin.

Red blood cell transfusion can also be used to recover from an operation that has caused major blood loss.

Medical nutrition

In the international clinic Medica24 we pay great attention to the proper nutrition of patients, especially those suffering from oncological diseases. The daily diet contains foods rich in proteins, iron, folic acid, vitamin B12, which are necessary for normal blood formation and maintaining hemoglobin levels. In severe lesions of the gastrointestinal tract, when the patient cannot eat normally, parenteral nutrition is used.

Medications

For iron deficiency anemia, we prescribe iron supplements. They can be taken as tablets, but a more effective method of administration is intravenous, using a dropper. Complex preparations containing folic acid, vitamin B12, intramuscular injections of vitamin B12 are also used.

Erythropoietin preparations, a synthetic analog of a hormone produced by the kidneys, are prescribed to stimulate the hematopoietic process. The question of the use of such drugs is decided individually, since in case of oncological diseases they can negatively affect the patient’s condition and the prognosis of the disease. However, in some cases, it is erythropoietin preparations that serve as an effective means of increasing hemoglobin.

Correction of chemotherapy

If it turned out that chemotherapy drugs were the cause of anemia, the question arises of its correction. It is always decided individually, based on a specific case. Stopping drugs can do more harm than good. In this case, the treatment of anemia should not have a negative impact on the overall results of therapy.

The material was prepared by a member of the International Society of Surgeons of Oncologists EESG, Candidate of Medical Sciences Petr Sergeev.

how to treat it and how to do it right

Author:
R.A. Tkachenko

04.02.2017

PDF article.

Based on the materials of the VII National Congress of Anesthesiologists of Ukraine

Anemia is common in surgical practice and often underestimated by clinicians. When seeing a patient with anemia before a planned surgical intervention, the doctor must answer several questions: what target hemoglobin level should be achieved in this patient, given the possible risk of intraoperative blood loss; what methods and how quickly anemia needs to be corrected; what causes anemia. Traditionally, RBC infusion is used to correct perioperative anemia, but this method is associated with a high incidence of serious adverse events, increased hospital morbidity and mortality. No wonder the treatment of anemia is receiving more and more attention in major medical forums. The VII National Congress of Anesthesiologists of Ukraine was no exception, the rich program of which included a number of reports on modern approaches to the treatment of this condition.

Chief specialist in obstetric resuscitation of the State Healthcare Institution of Kiev, head of the course of obstetric anesthesiology, NMAPE named after. P.L. Shupika, Doctor of Medical Sciences, Professor Ruslan Afanasyevich Tkachenko spoke about the problem of perioperative anemia in surgical patients, the risks associated with it, and modern methods for its correction.
At the beginning of his report, the professor drew attention to the fact that anemia is a fairly common condition. It is observed in 1.6 billion people, which is about 25% of the world’s population. The main factor contributing to the development of anemia and its global spread is iron deficiency. Most often, anemia develops due to unfavorable socio-economic living conditions and the nature of nutrition.
Another common cause of anemia is blood loss due to surgery. A meta-analysis of 19 studies showed that 24% of patients who underwent total hip or knee arthroplasty and 44% of patients with hip fracture had perioperative anemia (D.R. Spahn, 2010).
According to Shander et al. (2004), anemia develops in 22-75% of patients undergoing colorectal surgery and in 34% of cases after abdominal surgery.
More than 85% of patients with normal hematological parameters before surgery have confirmed iron deficiency after elective orthopedic intervention due to massive blood loss (Lasocki et al., 2012).
Patients are often anemic before surgery. A multicenter cohort study has shown that the prevalence of preoperative anemia in cardiac surgery patients ranges from 22 to 30% (K. Karkouti et al., 2008). It should be taken into account that anemia is a frequent complication of conditions such as chronic kidney disease, inflammatory bowel disease, cancer, chronic heart failure, etc. At the same time, the main pathophysiological mechanisms for the development of anemia are bleeding (acute and chronic), intestinal malabsorption, inflammation, violation of hematopoiesis or increased destruction of red blood cells. As a result of these diseases, many patients have anemia of varying severity even before surgery.
Preoperative anemia should be of particular concern to anesthesiologists and surgeons due to a significant deterioration in the postoperative prognosis. Prospective and retrospective cohort studies show that patients with preoperative anemia (Hb level <80 g/l) have worse postoperative outcomes and higher 30-day mortality compared with non-anemic patients.
So, Leichtle et al. (2011), using the database of the National Surgical Quality Improvement Program (NSQIP), analyzed the treatment outcomes of more than 23 thousand patients who underwent elective open or laparoscopic colectomy. The results showed that the presence of anemia is an independent predictor of postoperative complications and longer hospital stay.
Musallam et al. (2011) reviewed data from a prospective registry of 227,425 patients undergoing major non-cardiac surgery, of whom 69,229 (30.4%) had preoperative anemia (Hb <80 g/l). The authors found that preoperative anemia (even mild) is an independent adverse prognostic factor for increased postoperative mortality (0.78% without anemia and 4.61% with anemia) and postoperative complications (5,33 and 15, 67% respectively). Thus, the need for preoperative correction of anemia is beyond doubt.
Traditionally, allogeneic blood transfusions are used to treat moderate to severe preoperative anemia. As a rule, on the eve of surgery, 1-2 doses of red blood cells are transfused, depending on the initial level of hemoglobin. Immediately before the operation, one vial of crystalloids is prescribed to replenish fluid loss as a result of the “nothing per os” mode. During and after surgery, crystalloids are used to replace normal extracellular fluid losses and small intravascular losses. If blood loss increases, colloids are additionally used to compensate for intravascular volume losses, and, if necessary, erythrocyte mass.
But how safe is the described tactic? It is quite logical to assume that the outcome of blood transfusion largely depends on the amount of blood transfused. This is supported by a large-scale meta-analysis by Ferraris et al. (2012) with the participation of more than 900 thousand surgical patients, which showed a significant increase in hospital morbidity and mortality with an increase in the number of doses of transfused allogeneic blood. So, when transfusing 1-2 doses of erythrocyte mass, the morbidity and mortality rate was about 39and 8%, 3-4 doses – about 47 and 9%, 7-8 doses – about 53 and 14%, more than 10 doses – about 62 and 34%, respectively. Patients who did not receive RBC infusion had an morbidity rate of 11% and a mortality rate of less than 1%.
Meta-analysis by Chaiwat et al. (2009) showed that transfusion of an additional unit of red blood cells increased in-hospital mortality by 5%. However, it is not only the transfusion of allogeneic blood products that is dangerous. Therefore I.A. Hofmann et al. (2013) distinguish a triad of independent risk factors for adverse outcomes – anemia, blood loss and bleeding, transfusion.
According to data obtained in the UK, the most common causes of complications and mortality after blood transfusions are: transfusion of inappropriate blood components (39.6% of cases), anaphylactic reactions (18.5%), reactions of Rhesus conflict (10.8%) , improper storage conditions for blood components (10.6%), hemolytic reactions (6.7%), incorrect number of transfused blood components or lack of indications for their transfusion (6.3%), transfusion acute pulmonary insufficiency (3.9%).
According to a meta-analysis by Marik et al. (2008) the risks associated with blood transfusion exceeded the expected benefit from their use in 93% of studies.
The high frequency of negative consequences of allogeneic blood transfusion makes it necessary to limit its use and look for safer options for correcting anemia.
The decrease in the frequency of routine transfusion of blood products is evidenced by the data of A. Shander et al. (2012). So, for the period from 2000 to 2010. the number of blood transfusions in the Netherlands decreased from 650 to 550 thousand.
To date, there are no generally accepted recommendations for the treatment of perioperative anemia. The guidelines of the European Society of Anesthesiology for 2013 recommend assessing the hematological status of patients 4-8 weeks before a planned surgical intervention. In the presence of anemia and the risk of surgical bleeding, it is necessary to find out the cause of anemia (iron deficiency, kidney failure, inflammation, etc.). In the event that anemia is iron deficiency, oral or intravenous iron preparations should be prescribed.
As a rule, anemia is diagnosed on the basis of a reduced level of hemoglobin (less than 120-130 g/l) or hematocrit. However, the assessment of the body’s supply of iron only on the basis of the level of hemoglobin is very superficial and does not make it possible to reveal a hidden iron deficiency. It is known that in addition to the iron of erythrocytes, the body has deposited iron and a transport form of iron. Therefore, in order to assess the supply of iron, in addition to the level of hemoglobin, it is necessary to determine the content of ferritin (displays the state of the iron depot in the body, normally 30-300 µg / l) and saturation of transferrin (iron transport protein, normally 20-45%). A decrease in these indicators indicates the depletion of the iron depot in the body and its deficiency even with a normal level of hemoglobin, which requires appropriate correction.
Some experts believe that oral iron supplements are sufficient to correct iron deficiency anemia. However, this approach is characterized by a rather slow increase in hemoglobin levels. In particular, Quinn et al. (2010), using the example of surgical patients with colorectal cancer and initial anemia, showed that oral intake of 200 mg of ferrous sulfate three times a day for 40 days increases the hemoglobin concentration by an average of 17 g/l. That is, it can take up to several months to normalize the hemoglobin level (depending on its initial values). Many patients who are preparing for a planned surgical intervention may not have such a margin of time.
In addition, treatment with oral iron preparations is associated with a number of dose-dependent adverse reactions from the gastrointestinal tract (constipation, dyspepsia, diarrhea, heartburn, nausea, vomiting, flatulence). According to I.C. Macdougall (1999) listed side effects occur in 20% of patients taking ferrous sulfate. The tolerability of iron preparations may improve when taken with food, but, on the other hand, this leads to a decrease in iron absorption and, consequently, to a decrease in the effectiveness of therapy. Poor tolerability of oral iron preparations and the need to take them frequently reduce patient adherence to treatment. Oral ferric iron preparations are characterized by a lower frequency of adverse events, therefore it is desirable to prescribe them for oral administration.
These shortcomings are devoid of intravenous iron preparations, which, moreover, can significantly reduce the time for anemia correction compared to oral preparations.
In August 2013, a team led by Edward Litton published a systematic review and meta-analysis assessing the impact of intravenous iron supplementation on the need for allogeneic blood transfusion. The researchers note that against the background of intravenous iron therapy, there is a decrease in the need for blood transfusion by 26% with a rapid increase in hemoglobin concentration. These drugs did not increase mortality or adverse events.
It is important to note that the use of intravenous iron, in contrast to the transfusion of red blood cells, leads to a stable increase in hemoglobin concentration. After transfusion of blood products, an increase in hemoglobin content is observed only in the first week. In the future, the level of hemoglobin begins to progressively decrease.
Of the intravenous iron preparations, solutions containing ferric iron are considered safer. To date, the most studied drug in this group is ferric saccharate, well known to our doctors under the trade name Venofer. One vial of Venofer contains 100 mg of iron, which corresponds to a half dose of red blood cells.
In the case of intravenous drip, Venofer must be diluted in 0.9% sodium chloride solution in a ratio of 1:20, for example, 5 ml of Venofer (100 mg of iron) in 100 ml of 0.9% sodium chloride solution. To ensure the stability of the solution, dilution of the drug in larger than recommended volumes of saline is not allowed. Diluted 100 ml of the prepared solution of the drug is administered intravenously by drip for 15 minutes. The introduction of the maximum allowable single dose of 7 mg of iron per 1 kg of body weight should be carried out for at least 3.5 hours, regardless of the total dose of the drug.
After intravenous administration, iron from the complex is taken up mainly by the liver, spleen and bone marrow. At the second stage, iron is used for the synthesis of hemoglobin, myoglobin and other iron-containing enzymes or stored in the liver in the form of ferritin. The limitation of the maximum administered dose of the drug is associated with the peculiarities of Venofer’s metabolism. As an infusion, the maximum tolerated dose (500 mg of iron) can be given no more than once a week.
It is much easier to use an innovative intravenous iron preparation – ​Ferinject, which is a macromolecular carboxymaltose complex of ferric iron. First of all, when using it, there is no need for a sensitivity test. A dose of the drug containing up to 200 mg of iron can be administered intravenously as a bolus, and the maximum weekly dose containing 1000 mg of iron can be administered intravenously by drip for 15 minutes or by stream.
Thus, the use of modern and safe intravenous forms of iron preparations makes it possible to quickly restore the level of hemoglobin and avoid blood transfusion. This tactic for the treatment of anemia has undeniable advantages over blood transfusion, since in this case the frequency of side effects is significantly reduced and the survival of patients improves.

Prepared by Vyacheslav Kilimchuk
UA/XMP/1116/0241

• Number:
• Thematic issue “Surgery, Orthopedics, Traumatology” No. 4 (26), leaf fall 2016

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