Text / Deng Zhengliang (Director of Jide Chinese Medicine Clinic)
[Epoch Times, July 12, 2022]Anemia is a blood disorder in which the blood’s ability to carry oxygen is reduced due to a lower-than-normal number of red blood cells or reduced hemoglobin. When anemia develops slowly, symptoms are usually vague, with tiredness, weakness, shortness of breath, headache, and decreased exercise capacity. When acute anemia occurs, symptoms may include confusion, feeling like passing out, loss of consciousness, and increased thirst. Anemia must be severe before a person becomes noticeably pale. Anemia can be temporary or long-term and can range from mild to severe.
Treatment of anemia depends on the cause and severity. Oral folic acid or vitamin B12, or intramuscular injection of vitamin B12 are common methods.
Oral iron
Nutritional iron deficiency is common in developing countries. In most developing countries, two-thirds of children and women of reproductive age suffer from iron-deficiency anaemia. Iron deficiency due to insufficient dietary iron intake is rare in men and postmenopausal women. The diagnosis of iron deficiency can look for potential sources of blood loss, such as gastrointestinal bleeding from ulcers or colon cancer.
Mild to moderate iron deficiency anemia can be treated with oral supplementation with ferrous sulfate, ferrous fumarate, or ferrous gluconate. Daily iron supplementation has been shown to be effective in reducing anemia in women of reproductive age. Stomach upset or dark stools are common when taking iron supplements. Taking iron supplements with meals can relieve an upset stomach, however, this reduces iron absorption. Vitamin C helps the body’s ability to absorb iron, so taking an oral iron supplement with orange juice can be beneficial.
In anemia of chronic kidney disease, erythropoietin is recommended to stimulate erythropoiesis, and parenteral iron supplementation is recommended if both iron deficiency and inflammation are present.
iron injection
Parenteral iron may be used if oral iron has been shown to be ineffective, too slow, or absorbed (for example, in inflammatory conditions). Parenteral iron can rapidly improve iron stores and is effective in treating patients with postpartum hemorrhage, inflammatory bowel disease, and chronic heart failure. The body can absorb up to 6 mg of iron per day from the gastrointestinal tract. In many cases, patients were deficient in more than 1,000 mg of iron, which took several months to replenish. This can be given at the same time as erythropoietin to ensure there is enough iron to increase red blood cell production.
blood transfusion
Blood transfusions are not recommended for asymptomatic persons until hemoglobin is below 60-80 g/L (6-8 g/dL). Blood transfusions are recommended for patients with coronary artery disease only when hemoglobin is below 70 to 80 g/L (7 to 8 g/dL).
Erythropoiesis-stimulating agents
The purpose of using erythropoiesis-stimulating agents (ESAs) is to maintain hemoglobin levels to a minimum to minimize blood transfusions and meet the individual’s needs. They should not be used for mild or moderate anemia. It is not recommended for patients with chronic kidney disease unless the hemoglobin level is below 10 g/dL or symptoms of anemia are present. Their use should be combined with parenteral iron.
Hyperbaric oxygen
The treatment of anemia with abnormal blood loss is considered an indication for hyperbaric oxygen (HBO) by the Undersea and Hyperbaric Medical Society. HBO is recommended when a patient who cannot be transfused for medical or religious reasons cannot deliver oxygen to the tissue. HBO can be used clinically when blood product incompatibilities or concerns about communicable disease arise. Certain religious beliefs (eg: Jehovah’s Witnesses) may require the use of HBO’s methods.
Anemia before surgery
An estimated 30% of adults requiring non-cardiac surgery suffer from anemia. For appropriate preoperative treatment, it is recommended to first determine the cause of the anemia. Combined treatment with iron supplementation and erythropoietin may reduce the need for postoperative blood transfusions in patients with preoperative anemia.
Epidemiology
Anemia affects 27% of the world’s population, of which iron deficiency anemia accounts for more than 60%. Moderate iron deficiency anemia affects approximately 610 million people worldwide, or 8.8% of the population. Females accounted for 9.9%, more common than males at 7.8%. Mild iron deficiency anemia affects an additional 375 million people. Severe anaemia is prevalent globally, especially in sub-Saharan Africa, where it is associated with underlying causes of malaria and invasive bacterial infections. ◇
Responsible editor: Tang Yin
