The Rheumatologist
COVID-19 News
  • Connect with us:
  • Facebook
  • Twitter
  • LinkedIn
  • YouTube
  • Feed
  • Home
  • Conditions
    • Rheumatoid Arthritis
    • SLE (Lupus)
    • Crystal Arthritis
      • Gout Resource Center
    • Spondyloarthritis
    • Osteoarthritis
    • Soft Tissue Pain
    • Scleroderma
    • Vasculitis
    • Systemic Inflammatory Syndromes
    • Guidelines
  • Resource Centers
    • Ankylosing Spondylitis Resource Center
    • Gout Resource Center
    • Rheumatoid Arthritis Resource Center
    • Systemic Lupus Erythematosus Resource Center
  • Drug Updates
    • Biologics & Biosimilars
    • DMARDs & Immunosuppressives
    • Topical Drugs
    • Analgesics
    • Safety
    • Pharma Co. News
  • Professional Topics
    • Ethics
    • Legal
    • Legislation & Advocacy
    • Career Development
      • Certification
      • Education & Training
    • Awards
    • Profiles
    • President’s Perspective
    • Rheuminations
  • Practice Management
    • Billing/Coding
    • Quality Assurance/Improvement
    • Workforce
    • Facility
    • Patient Perspective
    • Electronic Health Records
    • Apps
    • Information Technology
    • From the College
    • Multimedia
      • Audio
      • Video
  • Resources
    • Issue Archives
    • ACR Convergence
      • Systemic Lupus Erythematosus Resource Center
      • Rheumatoid Arthritis Resource Center
      • Gout Resource Center
      • Abstracts
      • Meeting Reports
      • ACR Convergence Home
    • American College of Rheumatology
    • ACR ExamRheum
    • Research Reviews
    • ACR Journals
      • Arthritis & Rheumatology
      • Arthritis Care & Research
      • ACR Open Rheumatology
    • Rheumatology Image Library
    • Treatment Guidelines
    • Rheumatology Research Foundation
    • Events
  • About Us
    • Mission/Vision
    • Meet the Authors
    • Meet the Editors
    • Contribute to The Rheumatologist
    • Subscription
    • Contact
  • Advertise
  • Search
You are here: Home / Articles / How to Manage, Treat Anemia of Inflammation in Patients with Rheumatic Disease

How to Manage, Treat Anemia of Inflammation in Patients with Rheumatic Disease

December 17, 2017 • By Ruth Jessen Hickman, MD

  • Tweet
  • Email
Print-Friendly Version / Save PDF

He continues, “Once you start seeing that MCV approaching the lower end of the normal range, you can confirm it with a test like retic hemoglobin concentration, and then I think it is incumbent upon you to look for the source of blood loss.” According to recommended guidelines, all adult men and postmenopausal women with iron-deficiency anemia require screening for gastrointestinal malignancy. It is also important to note that other medical causes can less commonly be the source of a microcytic anemia, like lead poisoning.10

You Might Also Like
  • How to Manage Patients with Giant Cell Arteritis and Polymyalgia Rheumatica
  • Plasma Complement Activation in Rheumatic Diseases May Accelerate Coronary Artery Disease
  • Pediatric Rheumatology Research Highlights Successful Approaches to Manage Juvenile Rheumatic Diseases
Explore This Issue
December 2017
Also By This Author
  • The Demise of the Inpatient Rheumatology Unit

Dr. Koury recommends getting a hematology consult if there is any clinical confusion about a case or in particularly severe situations.

Diagnosis of Other Types of Anemia

Rheumatologists may also see some patients with a macrocytic anemia due to treatments like methotrexate, which slow the division of the cell and allow more protein accumulation between cell divisions. Dr. Koury notes, “Especially when I see an MCV of 100 or higher, it’s usually the methotrexate, and you can cut back the dosage and get improved red cell production, whereas if you have a heavy inflammatory component, you probably won’t see the response to reduced dosage.” Pernicious anemia, hypothyroidism, alcoholism, liver dysfunction and myelodysplastic syndrome are some other possible causes of a macrocytic anemia.11

Dr. Koury cautions rheumatologists to be aware of the possibility of a specific diagnostic situation in patients on medications that can increase the MCV. “If you have patients on a medication that is going to increase your MCV, and you have them on other medications that can lead them to have occult blood loss, they could develop a normocytic anemia. You might miss iron deficiency, because the microcytosis induced by too little iron is counterbalanced by methotrexate or other medications that induce macrocytosis.”

ad goes here:advert-2
ADVERTISEMENT
SCROLL TO CONTINUE

Hemolytic anemia can occur in patients with SLE or other autoimmune disorders. Hemolysis is associated with normal to elevated mean corpuscular volume, increased unconjugated bilirubin, increased lactate dehydrogenase and decreased haptoglobin levels. Dr. Koury notes, “Once you see a drop in the hematocrit, you probably need to look at the bilirubin—that’s a quick indicator, and you can look at haptoglobin. One of the best indicators is looking at the peripheral blood smear for spherocytes.” He also recommends getting a hematology consult if there is any clinical confusion about a case or in particularly severe situations.

Treatment of Anemia of Inflammation

We still lack good information about the best way to treat anemia of inflammation. It’s not clear in what specific situations iron, transfusions or erythropoietin-stimulating agents should be used. Clinicians may need to vary their therapeutic approach based on the underlying chronic condition, comorbidities and the specific needs of the individual patient.

ad goes here:advert-1
ADVERTISEMENT
SCROLL TO CONTINUE

Pages: 1 2 3 4 5 6 7 8 | Single Page

Filed Under: Conditions Tagged With: anemia, Cause, Clinical, Diagnosis, inflammation, kidney, macrocytic anemia, Management, outcome, pathophysiology, patient care, Rheumatic Disease, rheumatologist, rheumatology, systemic inflammatory syndrome, Test, Treatment, vitamin deficiencyIssue: December 2017

You Might Also Like:
  • How to Manage Patients with Giant Cell Arteritis and Polymyalgia Rheumatica
  • Plasma Complement Activation in Rheumatic Diseases May Accelerate Coronary Artery Disease
  • Pediatric Rheumatology Research Highlights Successful Approaches to Manage Juvenile Rheumatic Diseases
  • Long-Term Benefits, Risks of Biologic Disease-Modifying Anti-Rheumatic Drugs in Patients with RA

About Ruth Jessen Hickman, MD

Ruth Jessen Hickman, MD, was born and raised in eastern Kentucky, where she first cultivated her love of literature, writing and personal narratives. She attended Kenyon college, where she received a Bachelor of Arts in philosophy, summa cum laude. She worked with individuals with psychiatric conditions and later in a neuroscience lab at the University of Illinois, Chicago, before graduating from Indiana University Medical School in 2011. Instead of pursuing clinical medicine, Ruth opted to build on her strength of clearly explaining medical topics though a career as a freelance medical writer, writing both for lay people and for health professionals. She writes across the biomedical sciences, but holds strong interests in rheumatology, neurology, autoimmune diseases, genetics, and the intersection of broader social, cultural and emotional contexts with biomedical topics. Ruth now lives in Bloomington, Ind., with her husband, son and cat. She can be contacted via her website at ruthjessenhickman.com.

View more by this author»

Rheumatology Research Foundation

The Foundation is the largest private funding source for rheumatology research and training in the U.S.

Learn more »

ACR Convergence

Don’t miss rheumatology’s premier scientific meeting for anyone involved in research or the delivery of rheumatologic care or services.

Visit the ACR Convergence site »

Simple Tasks

Learn more about the ACR’s public awareness campaign and how you can get involved. Help increase visibility of rheumatic diseases and decrease the number of people left untreated.

Visit the Simple Tasks site »

The Rheumatologist newsmagazine reports on issues and trends in the management and treatment of rheumatic diseases. The Rheumatologist reaches 11,500 rheumatologists, internists, orthopedic surgeons, nurse practitioners, physician assistants, nurses, and other healthcare professionals who practice, research, or teach in the field of rheumatology.

About Us / Contact Us / Advertise / Privacy Policy / Terms of Use

  • Connect with us:
  • Facebook
  • Twitter
  • LinkedIn
  • YouTube
  • Feed

Copyright © 2006–2021 American College of Rheumatology. All rights reserved.

ISSN 1931-3268 (print)
ISSN 1931-3209 (online)

loading Cancel
Post was not sent - check your email addresses!
Email check failed, please try again
Sorry, your blog cannot share posts by email.
This site uses cookies: Find out more.