Anemia - Treatment

Bloodless Medicine. Bloodless medicine and surgery is a new field designed to reduce or minimize blood loss and transfusions. It also attempts to address the problems in treating certain religious groups, such Jehovah's Witnesses, who refuse transfusions. Some techniques involved in this field include new surgical procedures or drugs that minimize blood loss, the use of erythropoietin, volume expanders (administration of fluids to dilute blood), using tiny blood samples for testing, and methods (e.g., Cell Saver) for recovering and recycling blood during surgery.

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Recombinant Human Erythropoietin (rHuEPO)

Erythropoietin is the hormone that acts in the bone marrow to increase the production of red blood cells. It has been genetically engineered as recombinant human erythropoietin (rHuEPO) and is available as epoetin alfa (Epogen, Procrit, Eprex). Novel erythropoiesis stimulating protein (NESP), also called darbepoetin alfa (Aranesp) lasts longer in the blood than epoetin alfa and requires fewer injections.

Levels of erythropoietin are reduced in anemia of chronic disease. Injections of synthetic erythropoietin can help reduce the need for blood transfusions and improve quality of life measures. Erythropoietin is currently used for treating patients with anemia related to the following conditions:

Chronic kidney disease and diabetes. Erythropoietin is an important treatment for patients on dialysis and has proven to reduce the risk of death from heart disease and improve quality of life.
Cancer. Erythropoietin is administered to manage the anemia associated with chemotherapy and other cancer treatments.
Chronic heart failure. Erythropoietin and intravenous iron may improve cardiac and renal function.
Myelodysplastic syndromes (MDS). MDS is a blood and bone marrow disease that is related to leukemia. In MDS, the bone marrow does not produce enough blood cells. Patients require frequent blood transfusions, which can lead to anemia. Erythropoietin is given to produce more red blood cells along with drugs that stimulate white blood cells. Darbepoetin alfa (Aranesp) is also showing promise in treating the anemia associated with MDS
Rheumatoid arthritis (RA). Erythropoietin may be used in combination with intravenous iron supplementation to treat both adult and juvenile RA.
Inflammatory bowel disease. Erythropoietin plus iron supplementation can be beneficial for treating anemia associated with Crohn's disease and ulcerative colitis.
Hepatitis C. Erythropoietin may mitigate the effects of ribavirin-induced anemia.
HIV/AIDS. HIV-positive patients may develop anemia as a side effect of treatment with AZT or ribavirin (for co-infection with hepatitis C). Recent research has indicated that weekly injections of epoetin alfa may be as effective as a three times per week regimen.