How to treat anemia of chronic disease

The core of the treatment of anemia of chronic diseases is to prioritize the control of the primary chronic disease. After the underlying disease is stabilized, the anemia will be relieved in the vast majority of patients, and there is no need to take additional so-called "blood-tonifying drugs."

Last week I met a 62-year-old Aunt Zhang in the outpatient clinic. She has been suffering from rheumatoid arthritis for almost 8 years. In the past six months, she has been feeling out of breath when climbing two floors, and her face has turned sallow. I heard from neighbors in the community that she needed iron supplements for anemia. I bought two boxes of imported iron supplement oral liquid and drank it for three months. When I checked again, my hemoglobin did not rise at all, but my stomach kept acid reflux after drinking. After three tests for anemia, it was discovered that her ferritin was very high. It was not iron deficiency at all, but a typical anemia of chronic disease - many textbooks now call it inflammatory anemia. The root cause is iron utilization disorder caused by long-term inflammatory stimulation. To put it bluntly, there is no shortage of iron in your body at all. It is "locked" by inflammatory factors in the "iron warehouse" of macrophages. The available iron available to the hematopoietic bone marrow is pitifully small. It is like a granary full of grain, but the scheduling system is broken and there is still no rice for cooking in the canteen. If you transport grain to the granary at this time, it is completely useless. Instead, the warehouse may overflow, causing iron overload and damaging the liver and kidneys. Later, we adjusted her rheumatoid medication and lowered the inflammation indicators to the normal range. Only a month and a half later, her hemoglobin rose from 91g/L to 115g/L. Her fatigue was basically gone, and she no longer needed to take extra blood-replenishing foods.

Of course, not all cases just need to focus on treating the primary disease. Now, there are different considerations in the industry about whether to use additional erythropoietin: some doctors prefer to use it for a short period of time as long as the patient has obvious symptoms of anemia and the hemoglobin is lower than 100g/L, which can quickly increase the hemoglobin and improve production. Regarding quality of life, some doctors are more cautious and believe that erythropoietin may increase the risk of thrombosis. As long as the primary disease is well controlled and the hematopoietic function recovers on its own, there is no need to do anything unnecessary. The specific choice must be made based on the patient's basic disease and thrombosis risk. There is no absolute standard answer.

There are also a small number of patients with chronic diseases combined with true iron deficiency, such as long-term chronic gastrointestinal bleeding and poor daily dietary intake. In these cases, appropriate iron supplementation is indeed required, but the dosage and duration must be strictly controlled according to the doctor's instructions, and do not overdo it on your own. When many people hear about anemia, they first stew red date and longan soup and buy various online celebrity blood-enhancing health products. It is really unnecessary, especially for patients with diabetes and chronic kidney disease. These high-sugar and high-added foods will aggravate the underlying disease. Eat a normal meal, eat more lean meat, eggs, and dark green vegetables. It is enough to provide enough raw materials for blood production. It is much more effective than taking supplements blindly.

If you have basic diseases such as long-term chronic infection, rheumatism, immune disease, and chronic kidney disease, and have recently experienced inexplicable fatigue, dizziness, and white lips, don't make blind diagnoses and buy medicines on your own. Check your blood routine and anemia first to understand the type of anemia and then deal with it. You will spend less money and suffer less.