Treatment of the Anaemia of Chronic Disease - Iron, Transfusions or Human Recombinant Erythropoietin?

Further therapeutic options such as the use of iron chelating agents or other agents with an influence on the regulation of the cellular iron metabolism are in preclinical evaluation. It can, however, already be stated with regard to an appropriate management of patients with rheumatic diseases, regardless of the underlying disease, that ACD can be treated effectively.The anaemia of chronic disease is a concomitant phenomenon of various chronic infectious, neoplastic and autoimmune diseases. Whenever possible, the treatment of the Underlying disease is the treatment of choice. When this is not feasible at present blood transfusion, iron therapy and the Use of erythropoietic agents are further treatment options. Blood transfusions are reserved for the short-term Use in the case of life-threatening anaemia (Hb<6.5 g/dL) and for the management of surgical interventions. Iron supplements are recommended when the ACD is accompanied by an iron deficiency with complete depletion of iron stores. Supplementation of iron is also required before or in the course of erythropoietin treatment when the ACD is associated with a functional iron deficiency. A functional iron deficiency is characterised by normal or even increased iron stores ill combination with all increase of hypochromic red cells in the peripheral blood functioning as all indicator of an iron-deficient erythropoiesis. The intravenous administration of iron is more effective when compared to the Oral route. Patients with ACD and normal or increased iron stores (serum ferritin >100 mu g/L) without functional iron deficiency Should not be treated with iron. The erythropoietic stimulation with the currently available agents epoetin alfa, epoetin beta and darbepoetin can result in a nearly 100% therapeutic response provided the individual iron requirements are considered. Using erythropoietin in combination with iron in patients with RA and ACD, it has been shown that besides the correction of the haemoglobin deficit also disease activity as well as health-related (quality Of life could be approved. The risk-benefit ratio of the treatment of ACD regarding the Underlying disease has, however, not been fully evaluated so far. This is also true for the use of iron and erythropoietin in the treatment of ACD.