User:CicaVe/sandbox: Difference between revisions - Wikipedia

Line 2: Line 2:

== Treatment ==

The global market for anemia treatments is estimated at more than 23 billion USD per year and is growing rapidly because of the rising prevalence and awareness of anemia. The types of anemia treated with drugs are iron-deficiency anemia, [[thalassemia]], aplastic anemia, [[hemolytic anemia]], [[Sickle cell disease|sickle cell anemia]], and pernicious anemia, the most important of them being deficiency and sickle cell anemia with together 60% of market share because of highest prevalence as well as higher treatment costs compared with other types<ref>”Anemia Treatment Drugs: 2019 Global Market Study; Analyzed by Type of Anemia, Type of Drug, and Geography”. ”GlobeNewswire” (Press release). April 26, 2019. Retrieved August 2, 2023.</ref>. Treatment for anemia depends on cause and severity. Vitamin supplements given orally ([[folic acid]] or vitamin B12) or intramuscularly ([[Cyanocobalamin|vitamin B12]]) will replace specific deficiencies.

Apart from that, iron supplements, antibiotics, immunosuppressants, bone marrow stimulants, corticosteroids, gene therapy, and iron chelating agents are forms of anemia treatment drugs, with immunosuppressants and corticosteroids accounting for 58% of the market share. A paradigm shift towards gene therapy and monoclonal antibody therapies is observed.

=== Oral Iron ===

Nutritional iron deficiency is common in developing nations. An estimated two-thirds of children and women of childbearing age in most developing nations are estimated to have iron deficiency without anemia, with one-third of them having an iron deficiency with anemia. Iron deficiency due to inadequate dietary iron intake is rare in men and postmenopausal women. The diagnosis of iron deficiency mandates a search for potential sources of blood loss, such as gastrointestinal bleeding from ulcers or colon cancer.[”[[Wikipedia:Citation needed|citation needed]]”]

Mild to moderate iron-deficiency anemia is treated by oral iron supplementation with [[Iron(II) sulfate|ferrous sulfate]], [[ferrous fumarate]], or [[ferrous gluconate]]. Daily iron supplements are effective in reducing anemia in women of childbearing age. When taking iron supplements, stomach upset or darkening of the feces are commonly experienced. The stomach upset can be alleviated by taking the iron with food; however, this decreases the amount of iron absorbed. [[Vitamin C]] aids in the body’s ability to absorb iron, so taking oral iron supplements with orange juice is of benefit.

In the anemia of chronic kidney disease, [[Recombinant protein|recombinant]] [[erythropoietin]] or [[epoetin alfa]] is recommended to stimulate RBC production, and if iron deficiency and inflammation are also present, concurrent [[parenteral iron]] is also recommended.

=== Injectable Iron ===

In cases where oral iron has either proven ineffective, would be too slow (for example, pre-operatively), or where absorption is impeded (for example, in cases of inflammation), [[parenteral iron]] preparations can be used. Parenteral iron can improve iron stores rapidly and is also effective for treating people with postpartum haemorrhage, inflammatory bowel disease, and chronic heart failure. The body can absorb up to 6 mg iron daily from the gastrointestinal tract. In many cases, the patient has a deficit of over 1,000 mg of iron, which would require several months to replace. This can be given concurrently with [[erythropoietin]] to ensure sufficient iron for increased rates of [[erythropoiesis]].

=== Blood Transfusions ===

Blood transfusions in those without symptoms is not recommended until the hemoglobin is below 60 to 80 g/L (6 to 8 g/dL). In those with [[coronary artery disease]] who are not actively bleeding transfusions are only recommended when the hemoglobin is below 70 to 80g/L (7 to 8 g/dL). Transfusing earlier does not improve survival. Transfusions otherwise should only be undertaken in cases of cardiovascular instability.

A 2012 review concluded that when considering blood transfusions for anaemia in people with advanced cancer who have fatigue and breathlessness (not related to cancer treatment or haemorrhage), consideration should be given to whether there are alternative strategies that can be tried before a blood transfusion.

=== Vitamin B12 Intramuscular Injections ===

In many cases, vitamin B12 is used by [[intramuscular injection]] in severe cases or cases of malabsorption of dietary-B12. Pernicious anemia caused by loss of intrinsic factor cannot be prevented. If there are other, reversible causes of low vitamin B12 levels, the cause must be treated.

Vitamin B12 deficiency anemia is usually easily treated by providing the necessary level of vitamin B12 supplementation. The injections are quick-acting, and symptoms usually go away within one to two weeks. As the condition improves, doses are reduced to weeks and then can be given monthly. Intramuscular therapy leads to more rapid improvement and should be considered in patients with severe deficiency or severe [[Neurological disorder|neurologic]] symptoms. Treatment should begin rapidly for severe neurological symptoms, as some changes can become permanent. In some individuals lifelong treatment may be needed.

=== Erythropoiesis-Stimulating Agents ===

The objective for the administration of an [[erythropoiesis-stimulating agent]] (ESA) is to maintain hemoglobin at the lowest level that both minimizes transfusions and meets the person’s needs. They should not be used for mild or moderate anemia. They are not recommended in people with [[chronic kidney disease]] unless hemoglobin levels are less than 10 g/dL or they have symptoms of anemia. Their use should be along with parenteral iron. The 2020 Cochrane Anaesthesia Review Group review of erythropoietin (EPO) plus iron versus control treatment including placebo or iron for preoperative anaemic adults undergoing non-cardiac surgery demonstrated that patients were much less likely to require red cell transfusion, and in those transfused, the volumes were unchanged (mean difference -0.09, 95% CI -0.23 to 0.05). Pre-operative hemoglobin concentration was increased in those receiving ‘high dose’ EPO, but not ‘low dose’.[”[[Wikipedia:Citation needed|citation needed]]”]

=== Hyperbaric Oxygen ===

Treatment of exceptional blood loss (anemia) is recognized as an indication for [[hyperbaric oxygen]] (HBO) by the [[Undersea and Hyperbaric Medical Society]]. The use of HBO is indicated when [[oxygen]] delivery to tissue is not sufficient in patients who cannot be given [[Blood transfusion|blood transfusions]] for [[medical]] or [[religious]] reasons. HBO may be used for medical reasons when the threat of [[blood product]] incompatibility or concern for [[Transmission (medicine)|transmissible disease]] are factors. The beliefs of some religions (ex: [[Jehovah’s Witnesses and blood transfusions|Jehovah’s Witnesses]]) may require they use the HBO method. A 2005 review of the use of HBO in severe anemia found that all publications reported positive results.

=== Preoperative Anemia ===

An estimated 30% of adults who require non-cardiac surgery have anemia. To determine an appropriate preoperative treatment, it is suggested that the cause of anemia be first determined. There is moderate level medical evidence that supports a combination of iron supplementation and erythropoietin treatment to help reduce the requirement for red blood cell transfusions after surgery in those who have preoperative anemia.

== Epidemiology ==

Anemia affects 27% of the world’s population, with iron-deficiency anemia accounting for more than 60% of it. A moderate degree of iron-deficiency anemia affected approximately 610 million people worldwide or 8.8% of the population. It is somewhat more common in females (9.9%) than males (7.8%). Mild iron-deficiency anemia affects another 375 million. Severe anaemia is prevalent globally, and especially in sub-Saharan Africa where it is associated with infections including malaria and invasive bacterial infections. Globally, the prevalence of anaemia in women aged 15 to 49 years increased from 28.5% in 2012 to 29.9% in 2019 and is projected to reach 32.3% by 2030, missing the [[Sustainable Development Goals|Sustainable Development Goal]] target of a 50 percent reduction by 2030.

# “Anemia Treatment Drugs: 2019 Global Market Study; Analyzed by Type of Anemia, Type of Drug, and Geography”. ”GlobeNewswire” (Press release). April 26, 2019. Retrieved August 2, 2023.

CHANGE CITATION NO.

The global market for anemia treatments is estimated at more than 23 billion USD per year and is growing rapidly because of the rising prevalence and awareness of anemia. The types of anemia treated with drugs are iron-deficiency anemia, thalassemia, aplastic anemia, hemolytic anemia, sickle cell anemia, and pernicious anemia, the most important of them being deficiency and sickle cell anemia with together 60% of market share because of highest prevalence as well as higher treatment costs compared with other types^[1]. Treatment for anemia depends on cause and severity. Vitamin supplements given orally (folic acid or vitamin B₁₂) or intramuscularly (vitamin B₁₂) will replace specific deficiencies^[2].

Nutritional iron deficiency is common in developing nations. An estimated two-thirds of children and women of childbearing age in most developing nations are estimated to have iron deficiency without anemia, with one-third of them having an iron deficiency with anemia^[3]. Iron deficiency due to inadequate dietary iron intake is rare in men and postmenopausal women. The diagnosis of iron deficiency mandates a search for potential sources of blood loss, such as gastrointestinal bleeding from ulcers or colon cancer.^{[citation needed]}

Mild to moderate iron-deficiency anemia is treated by oral iron supplementation with ferrous sulfate, ferrous fumarate, or ferrous gluconate. Daily iron supplements are effective in reducing anemia in women of childbearing age^[4]. When taking iron supplements, stomach upset or darkening of the feces are commonly experienced. The stomach upset can be alleviated by taking the iron with food; however, this decreases the amount of iron absorbed. Vitamin C aids in the body’s ability to absorb iron, so taking oral iron supplements with orange juice is of benefit^[5].

In the anemia of chronic kidney disease, recombinant erythropoietin or epoetin alfa is recommended to stimulate RBC production, and if iron deficiency and inflammation are also present, concurrent parenteral iron is also recommended^[6].

In cases where oral iron has either proven ineffective, would be too slow (for example, pre-operatively), or where absorption is impeded (for example, in cases of inflammation), parenteral iron preparations can be used. Parenteral iron can improve iron stores rapidly and is also effective for treating people with postpartum haemorrhage, inflammatory bowel disease, and chronic heart failure^[7]. The body can absorb up to 6 mg iron daily from the gastrointestinal tract. In many cases, the patient has a deficit of over 1,000 mg of iron, which would require several months to replace. This can be given concurrently with erythropoietin to ensure sufficient iron for increased rates of erythropoiesis^[8].

Blood transfusions in those without symptoms is not recommended until the hemoglobin is below 60 to 80 g/L (6 to 8 g/dL)^[2]. In those with coronary artery disease who are not actively bleeding transfusions are only recommended when the hemoglobin is below 70 to 80g/L (7 to 8 g/dL)^[9]. Transfusing earlier does not improve survival^[10]. Transfusions otherwise should only be undertaken in cases of cardiovascular instability^[11].

Vitamin B₁₂ Intramuscular Injections

[edit]

In many cases, vitamin B₁₂ is used by intramuscular injection in severe cases or cases of malabsorption of dietary-B₁₂. Pernicious anemia caused by loss of intrinsic factor cannot be prevented^[13]. If there are other, reversible causes of low vitamin B₁₂ levels, the cause must be treated^[14].

Vitamin B₁₂ deficiency anemia is usually easily treated by providing the necessary level of vitamin B₁₂ supplementation^[15]. The injections are quick-acting, and symptoms usually go away within one to two weeks^[15]. As the condition improves, doses are reduced to weeks and then can be given monthly. Intramuscular therapy leads to more rapid improvement and should be considered in patients with severe deficiency or severe neurologic symptoms^[15]. Treatment should begin rapidly for severe neurological symptoms, as some changes can become permanent^[16]. In some individuals lifelong treatment may be needed^[16].

Erythropoiesis-Stimulating Agents

[edit]

The objective for the administration of an erythropoiesis-stimulating agent (ESA) is to maintain hemoglobin at the lowest level that both minimizes transfusions and meets the person’s needs^[17]. They should not be used for mild or moderate anemia^[10]. They are not recommended in people with chronic kidney disease unless hemoglobin levels are less than 10 g/dL or they have symptoms of anemia. Their use should be along with parenteral iron^[17]^[18]. The 2020 Cochrane Anaesthesia Review Group review of erythropoietin (EPO) plus iron versus control treatment including placebo or iron for preoperative anaemic adults undergoing non-cardiac surgery^[19] demonstrated that patients were much less likely to require red cell transfusion, and in those transfused, the volumes were unchanged (mean difference -0.09, 95% CI -0.23 to 0.05). Pre-operative hemoglobin concentration was increased in those receiving ‘high dose’ EPO, but not ‘low dose’.^{[citation needed]}

Treatment of exceptional blood loss (anemia) is recognized as an indication for hyperbaric oxygen (HBO) by the Undersea and Hyperbaric Medical Society^[20]^[21]. The use of HBO is indicated when oxygen delivery to tissue is not sufficient in patients who cannot be given blood transfusions for medical or religious reasons. HBO may be used for medical reasons when the threat of blood product incompatibility or concern for transmissible disease are factors^[20]. The beliefs of some religions (ex: Jehovah’s Witnesses) may require they use the HBO method^[20]. A 2005 review of the use of HBO in severe anemia found that all publications reported positive results^[22].

Preoperative Anemia

[edit]

An estimated 30% of adults who require non-cardiac surgery have anemia^[23]. To determine an appropriate preoperative treatment, it is suggested that the cause of anemia be first determined^[24]. There is moderate level medical evidence that supports a combination of iron supplementation and erythropoietin treatment to help reduce the requirement for red blood cell transfusions after surgery in those who have preoperative anemia^[23].

Anemia affects 27% of the world’s population, with iron-deficiency anemia accounting for more than 60% of it^[25]. A moderate degree of iron-deficiency anemia affected approximately 610 million people worldwide or 8.8% of the population^[26]. It is somewhat more common in females (9.9%) than males (7.8%)^[26]. Mild iron-deficiency anemia affects another 375 million. Severe anaemia is prevalent globally, and especially in sub-Saharan Africa^[27] where it is associated with infections including malaria and invasive bacterial infections^[28]. Globally, the prevalence of anaemia in women aged 15 to 49 years increased from 28.5% in 2012 to 29.9% in 2019 and is projected to reach 32.3% by 2030, missing the Sustainable Development Goal target of a 50 percent reduction by 2030^[29].

“Anemia Treatment Drugs: 2019 Global Market Study; Analyzed by Type of Anemia, Type of Drug, and Geography”. GlobeNewswire (Press release). April 26, 2019. Retrieved August 2, 2023.

This is a user sandbox of CicaVe. You can use it for testing or practicing edits.
This is not the place where you work on your assigned article for a dashboard.wikiedu.org course.
Visit your Dashboard course page and follow the links for your assigned article in the My Articles section.

^ ^a ^b “Anemia Treatment Drugs: 2019 Global Market Study; Analyzed by Type of Anemia, Type of Drug, and Geography”. GlobeNewswire (Press release). April 26, 2019. Retrieved August 2, 2023.
^ ^a ^b Janz TG, Johnson RL, Rubenstein SD (November 2013). “Anemia in the emergency department: evaluation and treatment”. Emergency Medicine Practice. 15 (11): 1–15, quiz 15–16. PMID 24716235.
^ West CE (November 1996). “Strategies to control nutritional anemia”. The American Journal of Clinical Nutrition. 64 (5): 789–790. doi:10.1093/ajcn/64.5.789. PMID 8901803.
^ Low MS, Speedy J, Styles CE, De-Regil LM, Pasricha SR (April 18, 2016). “Daily iron supplementation for improving anaemia, iron status and health in menstruating women”. The Cochrane Database of Systematic Reviews. 2016 (4) CD009747. doi:10.1002/14651858.CD009747.pub2. PMC 10182438. PMID 27087396.
^ Sezer S, Ozdemir FN, Yakupoglu U, Arat Z, Turan M, Haberal M (April 2002). “Intravenous ascorbic acid administration for erythropoietin-hyporesponsive anemia in iron loaded hemodialysis patients”. Artificial Organs. 26 (4): 366–370. doi:10.1046/j.1525-1594.2002.06888.x. PMID 11952508.
^ “Anaemia management in people with chronic kidney disease | Guidance and guidelines | NICE”. February 9, 2011. Archived from the original on June 24, 2013. Retrieved August 9, 2013.
^ Ng O, Keeler BD, Mishra A, Simpson JA, Neal K, Al-Hassi HO, Brookes MJ, Acheson AG (December 7, 2019). “Iron therapy for preoperative anaemia”. Cochrane Database of Systematic Reviews. 2019 (12) CD011588. doi:10.1002/14651858.CD011588.pub3. PMC 6899074. PMID 31811820.
^ Auerbach M, Ballard H (2010). “Clinical use of intravenous iron: administration, efficacy, and safety”. Hematology. American Society of Hematology. Education Program. 2010: 338–347. doi:10.1182/asheducation-2010.1.338. PMID 21239816.
^ Qaseem A, Humphrey LL, Fitterman N, Starkey M, Shekelle P (December 2013). “Treatment of anemia in patients with heart disease: a clinical practice guideline from the American College of Physicians”. Annals of Internal Medicine. 159 (11): 770–779. doi:10.7326/0003-4819-159-11-201312030-00009. PMID 24297193. S2CID 4712203.
^ ^a ^b Kansagara D, Dyer E, Englander H, Fu R, Freeman M, Kagen D (December 2013). “Treatment of anemia in patients with heart disease: a systematic review”. Annals of Internal Medicine. 159 (11): 746–757. doi:10.7326/0003-4819-159-11-201312030-00007. PMID 24297191. S2CID 27062899.
^ Goddard AF, James MW, McIntyre AS, Scott BB (October 2011). “Guidelines for the management of iron deficiency anaemia”. Gut. 60 (10). British Society of Gastroenterology: 1309–1316. doi:10.1136/gut.2010.228874. PMID 21561874.
^ Preston NJ, Hurlow A, Brine J, Bennett MI (February 15, 2012). “Blood transfusions for anaemia in patients with advanced cancer”. Cochrane Database of Systematic Reviews. 2012 (2) CD009007. doi:10.1002/14651858.CD009007.pub2. PMC 7388847. PMID 22336857.
^ “Pernicious anemia: MedlinePlus Medical Encyclopedia”. medlineplus.gov. Retrieved August 4, 2022.
^ Hankey GJ (2008). Clinical neurology. Joanna M. Wardlaw. London: Manson. ISBN 978-1-84076-518-2. OCLC 503441695.
^ ^a ^b ^c Langan RC, Goodbred AJ (September 15, 2017). “Vitamin B12 Deficiency: Recognition and Management”. American Family Physician. 96 (6): 384–389. PMID 28925645.
^ ^a ^b “Pernicious Anemia Clinical Presentation: History, Physical Examination”. September 14, 2017. Archived from the original on September 14, 2017. Retrieved August 4, 2022.
^ ^a ^b Aapro MS, Link H (2008). “September 2007 update on EORTC guidelines and anemia management with erythropoiesis-stimulating agents”. The Oncologist. 13 Suppl 3 (Supplement 3): 33–36. doi:10.1634/theoncologist.13-S3-33. PMID 18458123.
^ American Society of Nephrology, “Five Things Physicians and Patients Should Question” (PDF), Choosing Wisely: an initiative of the ABIM Foundation, American Society of Nephrology, archived (PDF) from the original on April 16, 2012, retrieved August 17, 2012
^ Kaufner L, Heymann C (2020). “Erythropoietin plus iron versus control treatment including placebo or iron for preoperative anaemic adults undergoing non-cardiac surgery”. Cochrane Database of Systematic Reviews. 2020 (8) CD012451. doi:10.1002/14651858.CD012451.pub2. PMC 8095002. PMID 32790892.
^ ^a ^b ^c Undersea and Hyperbaric Medical Society. “Exceptional Blood Loss – Anemia”. Archived from the original on July 5, 2008. Retrieved May 19, 2008.
^ Undersea and Hyperbaric Medical Society. “Exceptional Blood Loss – Anemia”. Archived from the original on July 5, 2008. Retrieved May 19, 2008.
^ Van Meter KW (2005). “A systematic review of the application of hyperbaric oxygen in the treatment of severe anemia: an evidence-based approach”. Undersea & Hyperbaric Medicine. 32 (1): 61–83. PMID 15796315. Archived from the original on January 16, 2009.
^ ^a ^b Kaufner L, von Heymann C, Henkelmann A, Pace NL, Weibel S, Kranke P, Meerpohl JJ, Gill R (August 13, 2020). “Erythropoietin plus iron versus control treatment including placebo or iron for preoperative anaemic adults undergoing non-cardiac surgery”. Cochrane Database of Systematic Reviews. 2020 (8) CD012451. doi:10.1002/14651858.CD012451.pub2. PMC 8095002. PMID 32790892.
^ Kotzé A, Harris A, Baker C, Iqbal T, Lavies N, Richards T, Ryan K, Taylor C, Thomas D (November 2015). “British Committee for Standards in Haematology Guidelines on the Identification and Management of Pre-Operative Anaemia”. British Journal of Haematology. 171 (3): 322–331. doi:10.1111/bjh.13623. PMID 26343392. S2CID 37709527.
^ Kassebaum NJ, GBD 2013 Anemia Collaborators (2016). “The Global Burden of Anemia”. Hematology/Oncology Clinics of North America. 30 (2): 247–308. doi:10.1016/j.hoc.2015.11.002. PMID 27040955.
^ ^a ^b Vos T, et al. (December 2012). “Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010”. Lancet. 380 (9859): 2163–2196. doi:10.1016/S0140-6736(12)61729-2. PMC 6350784. PMID 23245607.
^ van Hensbroek MB, Jonker F, Bates I (September 2011). “Severe acquired anaemia in Africa: new concepts”. British Journal of Haematology. 154 (6): 690–5. doi:10.1111/j.1365-2141.2011.08761.x. PMID 21707575. S2CID 205268648.
^ Abuga KM, Muriuki JM, Williams TN, Atkinson SH (September 22, 2020). “How Severe Anaemia Might Influence the Risk of Invasive Bacterial Infections in African Children”. International Journal of Molecular Sciences. 21 (18): 6976. doi:10.3390/ijms21186976. PMC 7555399. PMID 32972031.
^ FAO, IFAD, UNICEF, WFP, WHO (2024). The State of Food Security and Nutrition in the World 2024. FAO; IFAD; UNICEF; WFP; WHO. doi:10.4060/cd1254en. ISBN 978-92-5-138882-2.