Wednesday, September 20, 2023

Blood Transfusion For Low Iron

Whats The Best Way To Eat Iron Rich Foods

Iron and blood transfusions – from Tonic TV

You can increase your iron absorption by having certain other foods, drinks and medications.

  • Red meat contains a lot ofiron.
  • Vitamin C increases your bodys absorption of iron. Fruits and leafy green vegetables are good sources of vitamin C. These are at their best when raw, lightly cooked or steamed.
  • Foods and drinks that reduce the amount of iron your body can absorb include chocolate, unprocessed bran, tea, coffee, red wine and cola drinks.
  • Antacids can also reduce iron absorption, as can other medications.

Whats The Best Food For Iron

There are two types of iron in food ‘haem iron’,which is found in meat, and ‘non-haem iron’,which is found in plants.

Your body absorbs haem iron much more easily than non-haem iron. Meat also contains a lot more iron than plants, however a well-balanced vegetarian diet can still provide enough iron.

Anemia And Red Blood Cell Transfusion In The Adult Non

Carolyn D. Burns

Independent Patient Blood Management Physician , , USA

Correspondence to:

Abstract: Anemia is a global health issue. It is associated with a wide variety of disease states in both medical and surgical patients. Increased morbidity and mortality are notable in patients with even mild anemia. Clinicians often consider red blood cell transfusions as first-line therapy for patients with anemia to raise the hemoglobin level and increase oxygen delivery. RBC transfusion in the hemorrhaging patient can be life- or limb-saving. However, RBC transfusion may result in serious adverse events, both acute and delayed, and thus, the medical decision to transfuse in the non-bleeding, anemic patient must be carefully considered. Recent literature identifies RBC transfusion practice, in a multitude of patient populations, can be readily avoided with attention placed on proper assessment of patient symptoms, optimal diagnosis of the etiology of the anemia, and appropriate treatment thereof. This review seeks to collate the current state of the science regarding RBC transfusions in the adult non-bleeding patient. Evidence-based alternatives to transfusion will also be briefly presented.

Keywords: Anemia red blood cells transfusion

Received: 06 August 2021 Accepted: 02 September 2021 Published: 31 March 2022.

doi: 10.21037/aob-21-51

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How We Care For Iron Deficiency Anemia

Children and young adults with anemia are treated by the Blood Disorders Center at the Dana-Farber/Boston Children’s Cancer and Blood Disorders Center. Our program brings together world-renown pediatric hematology specialists and support staff, including hematopathologists, hematology nurse practitioners, social workers, and designated hematology patient coordinators. For many appointments and certain procedures, your child can also receive care at one of Boston Children’s satellite offices.

Complications Of Blood Transfusions

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Most patients who receive a transfusion don’t suffer any adverse reactions. However, it’s still possible for reactions to occur with any blood component. A reaction can occur at the time of the transfusion or not until weeks or months later.

Symptoms and side effects that may occur during or soon after transfusion include:

  • A skin rash or hives
  • A drop in blood pressure
  • Dark or red urine

If you notice any of these changes during a transfusion, however slight, alert the nursing staff promptly. Serious complications can be prevented by recognizing a reaction early, stopping the transfusion and limiting the amount of blood given. Although rare, a hemolytic transfusion reaction can occur when transfused red cells are damaged or destroyed. This can result in a drop in blood pressure, bleeding or kidney damage that may be life-threatening.

Reactions that aren’t immediate include:

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What Are The Side Effects Of Intravenous Iron

The side effects of IV iron are usually minimal, but may include the following:

  • Bloating or swelling of the face, arms, hands, lower legs, or feet
  • Dizziness, faintness, or lightheadedness when getting up suddenly from a lying or sitting position
  • Gastrointestinal pains, including nausea and cramps
  • Problems with breathing
  • Low blood pressure

Identifying The Cause Of Iron Deficiency

Once iron deficiency anemia has been diagnosed, the cause of the iron deficiency should be identified because the underlying condition may require immediate management and predispose the patient to recurrence. To reduce unnecessary testing, we have proposed a diagnostic algorithm to distinguish which patients are in need of extensive gastrointestinal evaluation .

Iron therapy without further diagnostic evaluation may be initiated in endurance athletes, frequent blood donors, and pregnant women, groups that are predisposed to iron deficiency anemia. If anemia is severe, a gastrointestinal cause of iron deficiency may be considered. Adequate iron supplementation during pregnancy prevents complications associated with severe anemia .88 When oral iron exacerbates pregnancy-related nausea and vomiting, intravenous iron is a safe and effective alternative.72 If there is no adequate response to therapy, further gastrointestinal evaluation may be considered after delivery.

Pertinent points in the patient history include diet , nonsteroidal anti-inflammatory drug use, family history of hematologic disorders , and recent potential causes of blood loss , as well as a history of gastrointestinal disease.

If no criteria for gastrointestinal investigation are fulfilled, patients should be re-evaluated after 4 to 8 weeks of treatment. A switch to intravenous iron and further gastrointestinal investigation should be considered if there is no adequate response to initial therapy.

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Other Surgical And Medical Patients

Limiting unnecessary RBC transfusion in other surgical patients is likewise important. The American Society of Anesthesiologists practice guidelines for peri-operative management advocates for thorough assessment of bleeding risk, diagnosis and treatment of anemia and use of pharmacologic adjuncts to decrease blood loss all techniques which will minimize the need for allogeneic RBC transfusion . Restrictive transfusion practice is evidence-based, well-tolerated, safe, and applicable for orthopedic, burn, and surgical oncology patients . There remains some question as to the adequate Hgb level for patients undergoing major vascular surgery. Data is limited. A small pilot study of 58 patients showed higher death rates and major vascular complications with lower Hgb, < 8.0 g/dL . The authors called for further trials prior to extrapolating general restrictive thresholds to these patients.

A recent consensus statement regarding post-operative anemia management after major surgery has been published, helping to clarify interventions which furnish continuity of care for surgical patients before and after discharge .

What Is A Blood Transfusion

Safety and efficacy of intravenous iron therapy in reducing blood transfusion

A blood transfusion is when blood is put into the body. During a blood transfusion, you receive donated blood through one of your blood vessels. A needle is put into a vein, often in the arm. The needle is attached to a thin, flexible tube called a catheter. This is called an intravenous line, or IV. Blood is sent into your vein through this IV line.

Your blood has several parts. Plasma is the liquid part of your blood. Its made of water, proteins, clotting factors, hormones, and other substances.

Floating in the plasma are many red blood cells . These large cells contain hemoglobin. Hemoglobin lets RBCs carry oxygen from your lungs to the rest of your body. Your whole body needs oxygen, so its important to have enough RBCs.

Your blood also contains white blood cells. These help the body fight infection.

And your blood contains smaller cells called platelets. These help the blood clot. Proteins called clotting factors also help your blood clot. Without these, your body cant stop bleeding from even a tiny wound.

Whole blood refers to blood with all these parts. Most of the time, a blood transfusion is done with only part of the blood. You might be given one or more of these blood parts based on your needs.

Rh factor is another type of antigen. Blood is either Rh positive or Rh negative. Each persons blood is one of 8 specific types: A+, A, B+, B, AB+, AB, O+, and O.

Other blood types can donate and give to only their matching blood types.

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Our Areas Of Research For Iron Deficiency Anemia

Our physician scientists are conducting innovative research on anemias and red blood cell disorders. We have a long track record of innovation, and we are considered a world leader in laboratory and clinical research on blood disorders. Regarding iron deficiency anemia research specifically, we are conducting ongoing research on better ways to screen for iron deficiency and to predict who will respond to oral iron supplements. In addition, we are conducting studies to determine the molecular basis of iron-refractory iron deficiency anemia and other rare blood disorders.

How Is Iron Deficiency Treated

Even if the cause of the iron deficiency can be identified and treated, it is still usually necessary to take medicinal iron until the deficiency is corrected and the body’s iron stores are replenished. In some cases, if the cause cannot be identified or corrected, the patient may have to receive supplemental iron on an ongoing basis.

There are several ways to increase iron intake:

Diet

  • Meat: beef, pork, or lamb, especially organ meats such as liver
  • Poultry: chicken, turkey, and duck, especially liver and dark meat
  • Fish, especially shellfish, sardines, and anchovies
  • Leafy green members of the cabbage family including broccoli, kale, turnip greens, and collard greens
  • Legumes, including lima beans, peas, pinto beans, and black-eyed peas
  • Iron-enriched pastas, grains, rice, and cereals

Medicinal Iron

The amount of iron needed to treat patients with iron deficiency is higher than the amount found in most daily multivitamin supplements. The amount of iron prescribed by your doctor will be in milligrams of elemental iron. Most people with iron deficiency need 150-200 mg per day of elemental iron . Ask your doctor how many milligrams of iron you should be taking per day. If you take vitamins, bring them to your doctor’s visit to be sure.

Possible side effects of iron tablets include abdominal discomfort, nausea, vomiting, diarrhea, constipation, and dark stools.

Intravenous Iron

  • Ferric gluconate

Blood Transfusions

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Iron Infusion Vs Iron Injection

Iron infusions involve delivering a dose of iron through the vein with an IV drip. Iron injections involve injecting iron into a muscle with a needle. The injection is usually done into the buttocks. Iron infusions may take up to several hours, whereas iron injections deliver a whole dose immediately.

Iron infusions tend to be less painful than iron injections. Injections can also cause intramuscular bleeding and orange discoloration. Because of these possible complications, doctors often favor iron infusions over iron injections as treatment for iron deficiency anemia.

The Blood Transfusion Process

Iron IV Infusion

The average adult has about 5 litres of blood in their body and a blood transfusion is used to replace some of the lost blood. The blood is given intravenously through the patients vein by inserting a plastic tube into the vein. The blood transfusion replaces the red blood cell with new iron containing cells which are ready to carry oxygen around the body. However, some people do not want to have a blood transfusion and they have the right to refuse. This refusal may be the result of religious beliefs or other reasons and an alternative treatment could be an iron transfusion.

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Patients With Acute Coronary Syndromes

Concerns regarding restrictive RBC transfusion in patients with ACS or with underlying significant coronary artery disease are understandable given the need for high basal oxygen extraction by the myocardium, the limited tolerance to anaerobic metabolism, and the decreased flow through stenotic vessels. Data is conflicting in this population due to the heterogeneity among patients, for example, ST-elevation versus non-ST-elevation, lack of clear definitions for significant, yet chronic CAD, as well as the varied comorbidities which accompany these patients . The recent REALITY Trial randomized greater than 660 patients with AMI and anemia. The RBC transfusion threshold paradigm was 8.0 g/dL versus 10.0 g/dL. Those within the restrictive group had no increases in major adverse cardiac events after 30 days when compared to the liberal group . Ongoing trials continue , but, at this time, available evidence implies the potential for improved outcomes in patients with ACS with a Hgb threshold of 8.0 g/dL .

How Much Blood Do You Need

Getting a blood transfusion in the hospital can save your life. You may need a lot of blood if you are bleeding heavily because of an injury or illness.

But anemia is usually not urgent. And usually you dont need a lot of blood. You may only need one unit of blood while you are in the hospital. Or you may not need any blood at all. Heres why:

What is anemia?

If you have anemia, your blood doesnt have enough red blood cells, or they dont work properly. Red blood cells carry hemoglobin. This is an iron-rich protein that helps bring oxygen to the body. Anemia is measured in hemoglobin levels.

There are a number of reasons you may become anemic while you are in the hospital, including:

  • A chronic condition or disease

Extra blood units are not helpful.

A normal hemoglobin level is 11 to 18 grams per deciliter , depending on your age and gender. But 7 to 8 g/dL is a safe level. Your doctor should use just enough blood to get to this level. Often, one unit of blood is enough.

Some doctors believe that hospital patients who fall below 10 g/dL should get a blood transfusion. But recent research found that:

  • Many patients with levels between 7 and 10 g/dL may not need a blood transfusion.
  • One unit of blood is usually as good as two, and it may even be safer.
  • Some patients in intensive care may do better when they receive less blood.

Using more blood units may increase risks.

In the U.S., the blood is generally very safe . The risks when you get blood are very small. They include:

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Iron Therapy And Carcinogenesis

Iron homeostasis is tightly regulated to protect against redox damage by free iron yet still provide enough iron for erythropoiesis and cellular function. Fe iron reacts with hydrogen peroxide to form highly reactive hydroxyl radicals . Hydroxyl radicals react with all biomolecules, and they can damage nucleotide bases and cause DNA strand breaks.46,121 One concern in iron therapy is the potential for tumor promotion or progression.

Several NHANES studies122124 have found that a high TfS , in combination with high iron intake, increases cancer risk. In contrast, the Swedish AMORIS study125 found a positive association between total iron-binding capacity, which increases when the level of available iron is low, and cancer risk. Population studies have found an association between a high level of consumption of red meat and increased colorectal cancer risk,126,127 but not when the study population is female.128,129 These incongruous results are likely due to a variety of other factors, such as geographic differences in diet, prevalence of disease, and prevalence of iron deficiency.

Unfortunately, few studies have directly compared drugs, and the long-term consequences of iron therapy with respect to carcinogenesis are as of yet unclear . Nevertheless, the adequate and appropriate administration of iron should diminish the risk of iron oversupply, especially in the context of iron deficiency anemia.

What Are The Different Kinds Of Anemia

The Effects of Blood Transfusions on Iron Accumulation

The types of anemia are based on what causes them. They include:

  • Anemias from when red blood cells get broken down too fast, called hemolytic anemias. They include:
  • autoimmune hemolytic anemia: when the body’s immune system destroys its own red blood cells
  • inherited hemolytic anemias: these include sickle cell disease, thalassemia, G6PD deficiency, and hereditary spherocytosis
  • Anemia from bleeding. This can happen due to bleeding from an injury, heavy menstrual periods, the gastrointestinal tract, or another medical problem.
  • Anemia from red blood cells being made too slowly, such as:
  • aplastic anemia: when the body stops making red blood cells from an infection, illness, or other cause
  • iron-deficiency anemia: when someone doesn’t have enough iron in their diet
  • anemia B12 deficiency: when someone doesn’t get enough B12 in the diet or the body can’t absorb the B12
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    Enhancing Healthcare Team Outcomes

    Communication between primary clinicians, hematologists, nurses, and other health care staff is essential for early diagnosis and management of transfusion iron overload. Adherence to follow up and iron-chelation therapy have shown an overall improvement in both morbidity and mortality. The psychological effect of long-term transfusion therapy is common, and early evaluation of depression, anxiety, and other disorders is important. Financial implications for long term therapy should also be considered.

    Management Of Iron Deficiency Anemia

    There is clear evidence to support prompt treatment in all patients with iron deficiency anemia because it is known that treatment improves quality of life and physical condition as well as alleviates fatigue and cognitive deficits.820 Although clear evidence is lacking, iron deficiency without anemia is associated with RLS and chronic fatigue, and treatment alleviates these symptoms.7,1418 In CHF, iron replacement therapy has been shown to be beneficial, even when anemia is not present.8,1214 Thus, the decision to treat iron deficiency in a patient without manifest anemia must be made on an individual basis.53,54 The treatment of iron deficiency anemia in patients with CKD, CHF, or cancer should be undertaken in conjunction with the appropriate specialists because different guidelines may apply.

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    Why Might I Need A Blood Transfusion

    You might need a blood transfusion if youve had a problem such as:

    • A serious injury thats caused major blood loss
    • Surgery thats caused a lot of blood loss
    • Blood loss after childbirth
    • A liver problem that makes your body unable to create certain blood parts
    • A bleeding disorder such as hemophilia
    • An illness that causes reduced or poor-quality RBCs
    • Kidney failure, which causes problems with blood cell production
    • Treatment for cancer that slows down your bodys production of blood cells

    Different medical problems may need different types of blood transfusions. For example, after surgery you may need just RBCs. You might need plasma if you have a severe infection. A person being treated for cancer may need platelets. Your healthcare provider can tell you why you need a blood transfusion, and which type is best for you.

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