Nonpharmacologic Therapy

The most important nonpharmacologic treatment of anemia is the transfusion of RBCs. However, because of the risk of infection, immunosuppression, and microcir-culatory complications and the high cost of the procedure, the threshold for transfusion has been debated.11 Generally, only patients requiring immediate correction such as those with acute symptoms, receive blood transfusions. Determining which patient requires immediate correction is left to the health care provider. Usually, symptomatic patients who present with a Hgb concentration of 7 to 8 g/dL (70-80 g/L or 4.34-4.96 mmol/L) are candidates for transfusion.12

Other than transfusion, nonpharmacologic therapy plays a limited role in the management of anemia. Certainly, some causes of anemia can be attributed to diets poor in iron, folic acid, or vitamin B12. However, in the United States, nutrient-poor diets are rarely the sole cause of anemia in a patient. Therefore, ingesting a diet that is rich in iron, folic acid, or vitamin B12 should be encouraged but it is rarely the sole modality of treatment. Food sources of iron, folic acid, and vitamin B12 are listed in Table 66-2. 5

Table 66-1 Pertinent Laboratory Tests in the Evaluation of Anemia

Test Name_Normal flange__DescrlptlonrSlgnlfltante cnc

Mjb-; M ■ lü!> 9ML (UO-ÜSg/T. Of SjM-IMmmcVLt faute: (7.3-15.3(^1. ÎU3-153Ç/1 ûf JAi-Í.S mmol/1, )

(J.S-iSX KV'ceUs/Lt ípiuto: 41-5.1 X Iff çeHi/ml H.I-5.1 X 10' cells/U

Anrnmrof H.iL: in [he tfoixl: tt^iillirc enteil i .iiiyiiHK.iílúúly of (he bkx>d and determines fa parliert is anemic

T^cpetc«^ of bkwdïhat the crylfrocytc* encompass; also indiMnc-s 111 m Tan the I h)t> b nrk^uin I. <W¡ tiot 41.1 < ul iiíi F The number of «ythrocyles In a volume of Wood, aho Indicates jne"i>*.bu( seUum us«d

R6C Indices

A vilely ltJ\ I I.XVII.IIlH y YjätP M Íl'if ïsmjii* IÏBC MJO': hïUVf (/."Jlh."^

indicate maciocylosls and lo^w values indícale mcrocytosis imoiiíii'oí hQbper msc; nruy öedotr-wsedin im

Hgb divided try 1 he Ilc1; also 4cnv In IIÏA

Iron Studies

-iS-[60 mcg/dl (9.1 -ISM (jmo4/L) hWsum amountof Irofi bound loHansfeniin, Sowin IDA

30"lWmfi>tlL prnot/U

îertim ferritin


Other T*ltl

RBC distribution width


A^tkqiiJocyDe count Mitas fpmjto

Folk Jtuf Ifj'LjLJiij'l folk: Jfc'iri IFIHÎ ] Wamin B,.

Le« tho<t I0-Ä3 mcyA (Î2-+1 pmol/l } JJÛ-tAi moq/dt £J94-7i_i[j™stli

0.5-lïW BKs (OJOOS-ÛÛ2Î} ftS-î-S* of R9C5 0OOO5-OJÛÎ5) 11 -1 Î.4 nqAnl. w mctf/l P-20 nmoVLÎ lïi*«B ngAnL [JSï.],3Wmvol/L) 180-600 pg/hiL (13Î-730 pnraM.) MS mlUflïil [2-25ILVL1

Ferrilin Ii the [¡rDte^-ircjn-cornpfexiourKi in mac rophay« u«d fin IrQfl SHX-99^ Krvv In I[1A N'c.i^un«. the capjeltyohiandHim to bind Iran; high In IDA

Ii.Al = (Lcruni Eron/TlKJ h WOti saliMaflongf less Ilun lLAk common in ida

A higher value mearnltw preiemeof manydiHerer« h/fi (V

HBCv ine wcv üihcttiiwiHi rdijuk?

itnKjkj H» (¡leveled in pal iwflv wtio dfe rt^spcJii'rqlo Ueflimeffl

Uicd to determine Polt acid dL-flclera)1 üsfdin dpiwrriine Mt a:id fWlciffïty Uied 1o determine vilamn B delic ¡ency Patiero^ nny ir iioon i Po qhcfapy il (hey jie jnr^n k. jiyl EPO lowlturt* normal a in-iJhy clevutixl

Eft), erythropoietin; Ht I. hetruloc ril; Hgb. hemoglolïiii; MCH, niejrr cell hemoglobin, MC HC, mean tell hemogkjbài toncentriilon MCV, mt-än tdi YöiufTHi now. net dKinbUfan width; tibc. iciji iro^-birding «(»city: TyiT. lumiouim wnuwtioni

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