Iv Management With Co
There are no data that guide the management of anemia in patients with HF who have concomitant comorbidities including renal impairment and diabetes mellitus.
It would be useful, however, to review the available experience in the predominantly non-HF population.
Chronic kidney disease with anemia
Two studies have suggested that achievement of a higher hematocrit or hemoglobin target was associated with higher cardiovascular risk. In the United States Normal Hematocrit trial, hemodialysis patients with a baseline hematocrit of 27% to 33% were randomly assigned to receive epoetin to a target hematocrit of either 30% or 42%.
The study was terminated prematurely because of a trend toward higher mortality and myocardial infarction in the higher hematocrit group. In the Correction of Hemoglobin and Outcomes in Renal Insufficiency study, patients with chronic renal failure and anemia were randomly assigned to receive epoetin alfa to achieve a target hemoglobin of 13.5 g/dl or 11.3 g/dl.
The higher hemoglobin target group experienced an increased incidence of the composite endpoint . Only 23% of the patients in CHOIR had a history of HF.
Chronic kidney disease, diabetes mellitus, and anemia
Therefore, the available data derived primarily from non-HF patients do not support targeting a higher level of hemoglobin with the use of ESAs.
Anemia Associated With Chronic Heart Failure: Current Concepts
Accepted for publication 10 November 2012
4 February 2013Volume 2013:8 Pages 111122
Video abstract presented by Ravish Shah and Anil K Agarwal
Ravish Shah, Anil K AgarwalDivision of Nephrology, The Ohio State University, Columbus, Ohio, USAAbstract: Anemia is a frequent comorbidity of heart failure and is associated with poor outcomes. Anemia in heart failure is considered to develop due to a complex interaction of iron deficiency, kidney disease, and cytokine production, although micronutrient insufficiency and blood loss may contribute. Currently, treatment of anemia of heart failure lacks clear targets and specific therapy is not defined. Intravenous iron use has been shown to benefit anemic as well as nonanemic patients with heart failure. Treatment with erythropoietin-stimulating agents has been considered alone or in combination with iron, but robust evidence to dictate clear guidelines is not currently available. Available and emerging new agents in the treatment of anemia of heart failure will need to be tested in randomized, controlled studies.Keywords: anemia, heart failure, chronic kidney disease, elderly population
C Laboratory Tests To Monitor Response To And Adjustments In Management
The use of iron supplementation for the correction of iron deficiency anemia could be monitored by repeating hemoglobin in 4 weeks and 8 weeks . Restoring iron stores requires a minimum of 6 months of treatment. In the occasional patient who fails to respond to oral supplementation, an intravenous preparation could be considered.
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Case : Anemia Due To An Unrelated Comorbidity In A Patient With Hf
A 67-year-old postmenopausal woman was referred for evaluation and management of anemia. She had well-compensated NYHA class II HFrEF but had started feeling increasingly dyspneic on exertion over the past 6 months. She did not smoke or drink alcohol. There was no history of bleeding. LVEF was 40%, unchanged from 1 year ago, and CXR was normal.
Laboratory investigations demonstrated anemia . WBC, differential and platelet counts, reticulocyte count, thyrotropin, liver function tests, and serum creatinine, B12, and folate levels were normal. TSAT was 16%, and ferritin level was 225 g/L. Peripheral blood smear examination showed macrocytic erythrocytes and a population of bilobed neutrophils lacking normal cytoplasmic granulation.
Bone marrow biopsy revealed multilineage dysplasia, 7% blasts, and normal cytogenetics, consistent with myelodysplastic syndrome .; Some stainable iron was present in the bone marrow. She received treatment with subcutaneous azacitidine, which resulted in improvement in symptoms and Hb.;
How Is Anemia Treated
First, your healthcare provider will find out if the anemia is being caused by a poor diet or a more serious health problem. Then, you can be treated for both the anemia and its cause. Iron-deficiency anemia is treated with:
- Iron supplements taken by mouth.
- Foods high in iron and foods that help your body absorb iron .
- Iron given through an intravenous infusion.
- Transfusions of red blood cells.
If your anemia is caused by internal bleeding, your provider may need to do surgery to stop it. Surgical repair has been used to cure anemia in people with the paraesophageal type of hiatal hernias, with or without ulcers .
Other types of anemia may require other types of treatment. For instance, genetic disorders may require bone marrow transplant.
If CKD is causing your anemia, in addition to iron supplementation , treatment could also include injections of erythropoietin . EPO is a hormone that tells the bone marrow to make red blood cells.
Anemia is also linked to cancer in some cases both in terms of anemia being a symptom and in terms of cancer treatment. Both radiation and chemotherapy can cause anemia. It might be necessary to stall further cancer treatment until the anemia is improved by iron, blood transfusions, getting necessary B vitamins and/or getting shots of drugs to stimulate your body to produce EPO.
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Case : Acute Postoperative Anemia In A Patient With Hfref
An inpatient hematology consultation was requested for management of anemia in an 80-year-old woman who underwent coronary artery bypass grafting and bioprosthetic aortic valve replacement 7 days previously. Cardiac history was notable for HFrEF , dyspnea, and angina with minimal exertion, with 3-vessel coronary artery disease and severe aortic stenosis. Prior to surgery, Hb was 12.5 g/dL. WBC, differential, platelet counts, and creatinine level were normal. Other than development of postoperative anemia , she was asymptomatic, recovering uneventfully on a surgical ward. Pulse was 85 bpm; blood pressure was 115/70 mm Hg, and respiratory rate was 14/min. The patient was concerned that she was not receiving transfusions to restore the considerable drop in Hb.
Who Can Help Treat My Anemia
Fortunately, anemia is treatable under proper medical supervision. If youre experiencing some of these symptoms and think that you might be anemic, the medical team at Texas Medical Institute can help.
If you have any questions about our clinic or would like to schedule an appointment, contact us today by calling 615-8633, or request an appointment now via our online form. We look forward to helping you enjoy ultimate health and wellness!
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Which Foods Should I Eat And Which Foods Should I Avoid If I Have Anemia
With anemia, making good food choices is important. Eating junk food means you are getting calories without nutrients. You also have to consider other medical conditions that you have when you make your food choices.
Some things have been shown to impair iron absorption. You should not take calcium and iron supplements at the same time. In addition, you may want to avoid or limit these items:
- Tannin-containing items like coffee, tea and some spices.
- Egg whites.
- Soy protein.
In general, you should eat iron-rich foods and foods that provide vitamins B12, B9 and C. This means that you can enjoy plenty of good food that is for you, whether you eat meat or not. You can get iron from plant sources like lentils, spinach and pistachios. You can get iron from protein sources like lean beef and turkey. Whole grains and dark leafy vegetables are good sources of B vitamins. Some foods are even fortified with iron.
Citrus fruits, berries and other vitamin C-containing foods like peppers and tomatoes improve iron consumption. It is a good idea to get advice from your healthcare provider or perhaps from a registered dietitian about the best ways to eat when you have anemia. Also, make sure that grapefruit does not interfere with any of your medications.
Research For Your Health
The NHLBI is part of the U.S. Department of Health and Human Services National Institutes of Health the Nations biomedical agency that makes important scientific discoveries to improve health and save lives. We are committed to advancing science and translating discoveries into clinical practice to promote the prevention and treatment of heart, lung, blood, and sleep disorders, including iron-deficiency anemia. Learn about the current and future NHLBI efforts to improve health through research and scientific discovery.
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Is There A Link Between Anemia And Heart Disease
Anemia is prevalent among people with heart disease and is associated with worse outcomes.
Anemia occurs when your blood does not have enough hemoglobin, the protein found in red blood cells. Red blood cells transport oxygen from the lungs to cells throughout the body. Red blood cells also take carbon dioxide produced by cells and deliver it to the lungs for removal from the body.
The most common type of anemia is iron-deficiency anemia. This type occurs when your body doesn’t have enough iron to build healthy red blood cells. Low iron levels can have multiple causes, including blood loss, pregnancy, poor diet, or an inability to absorb enough iron from food.
Anemia is prevalent among people with cardiovascular disease, including people with heart failure and coronary artery disease, though the relationship between the conditions is not fully understood.
Hemoglobin and the heart When a person has low levels of hemoglobin, it results in lower levels of oxygen available in the body. This can make the heart work harder to supply the cells with oxygen. This can put the heart at greater risk for problems such as murmurs, arrythmias, enlarged heart, and heart failure.
Anemia is associated with worse outcomes in patients with heart disease. People who have heart disease and anemia are more likely to experience poorer outcomes, including poorer quality of life, an increased risk of hospitalization, and an increased risk of death.
How To Treat Anemia
If youre suffering from symptoms of anemia, see your doctor. He/she can run the appropriate tests, check for underlying health problems, and prescribe the right course of treatment.
What should you expect? In most cases, anemia treatment involves supplementing with iron . If the underlying cause of anemia is blood loss , then the source of the bleeding should also be located and stopped. Usually, thats all it takes to solve the problem.
With anemia of chronic disease, though, more extensive treatment may be needed. Some research has shown that, in severe cases, blood transfusions, intravenous delivery of iron, and injections of erythropoietin can be very helpful.
One caveatIts important to keep in mind that iron can be a pro-oxidant, meaning it can lead to greater oxidative stress in the body if not used correctly. For this reason, the only people who should supplement with iron as a matter of course are menstruating and pregnant women. Iron supplementation is usually safe for children, but discuss dosing with your childs pediatrician beforehand. Men, postmenopausal women, and all others should only take iron under the care and supervision of their doctors.
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Heart Failure: Pumping And Filling Problems
Normally, the heart stretches as it fills with blood , then contracts to pump out the blood . The main pumping chambers in the heart are the ventricles.
Heart failure due to systolic dysfunction usually develops because the heart cannot contract normally. It may fill with blood, but the heart cannot pump out as much of the blood it contains because the muscle is weaker or because a heart valve malfunctions. As a result, the amount of blood pumped to the body and to the lungs is reduced, and the ventricle usually enlarges.
Heart failure due to diastolic dysfunction develops because the heart muscle stiffens and may thicken so that the heart cannot fill normally with blood. Consequently, blood backs up in the left atrium and lung blood vessels and causes congestion. Nonetheless, the heart may be able to pump out a normal percentage of the blood it receives .
The heart chambers always contain some blood, but different amounts of blood may enter or leave the chambers with each heartbeat as indicated by the thickness of the arrows.
Anemia Of Chronic Disease
The anemia cause that concerns me most as a cardiologist is whats called anemia of chronic disease. With this form of anemia, the body does not efficiently recycle iron from blood cells, so they do not live as long as they should. The body also stops responding properly to erythropoietin, a hormone produced by the kidneys thats responsible for boosting red blood cell production.
People with certain long-term medical conditions that involve inflammation, including some cancers and autoimmune disorders, hepatitis, kidney disease, and congestive heart failure often become anemic. In fact, a meta-analysis of 34 studies and more than 153,000 CHF patients found that 37.2 percent of them had anemia. After a six-month follow-up, 46.8 percent of the anemic patients died compared with 29.5 percent without anemia.
Anemia also causes reduced blood flow to the kidneys, which leads to fluid retention, which places even further stress on the heart. Additionally, chronic anemia can result in left ventricular hypertrophy, the enlargement and thickening of the walls of the left ventriclethe hearts main pumping chamber. This can worsen congestive heart failure and set up what researchers call a vicious cycle wherein CHF causes anemia, and the anemia causes more CHF, and both damage the kidneys, worsening the anemia and the CHF further.
Types Of Heart Failure
The types of heart failure are classified by the ejection fraction , which is the percentage of blood pumped out by the heart with each beat and is a measure of how well the heart is pumping. A normal left ventricle ejects about 55 to 60% of the blood in it.
In heart failure with reduced ejection fraction :
The heart contracts less forcefully and pumps out a lower percentage of the blood that is returned to it. As a result, more blood remains in the heart. Blood then accumulates in the lungs, veins, or both.
In heart failure with preserved ejection fraction :
The heart is stiff and does not relax normally after contracting, which impairs its ability to fill with blood. The heart contracts normally, so it is able to pump a normal proportion of blood out of the ventricles, but the total amount pumped with each contraction may be less. Sometimes the stiff heart compensates for its poor filling by pumping out an even higher proportion of the blood than it normally does. However, eventually, as in systolic heart failure, the blood returning to the heart accumulates in the lungs or veins.
Heart failure with mid-range ejection fraction is a newer concept that includes people whose ejection fraction is somewhere between preserved and reduced ejection fraction.
B History Part : Prevalence:
The prevalence of anemia in HF varies according to the definition used, and patient population . The overall prevalence in community patients with heart failure approaches 50%.
The prevalence of anemia in HF appears to be increasing as is evident in a study in Olmsted County in two periods , and . The reason for the increasing prevalence of anemia has been attributed to the increasing prevalence of diastolic HF.
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How To Prevent Complications
Heart failure may get worse over time if you don’t treat it. Severe heart failure can be life threatening.
Treatments like weight loss, a healthy diet, exercise, and medicines can protect your heart and keep you healthy. Follow your doctor’s advice and stick with your treatment plan. The better you take care of your heart, the less likely you are to have other problems.
Mayo Clinic: Heart failure: âComplications,” “Definition,” âLifestyle and home remedies,â “Treatments and drugs,” “Pulmonary edema: Causes,” âVenous thromboembolism.â
American Heart Association: “Roles of Your Four Heart Valves,” “What is Atrial Fibrillation ?” “What is Heart Failure?”
UpToDate: “Patient Education: Heart failure .”
National Heart, Lung, and Blood Institute: “What Causes Heart Valve Disease?” âWhat Is Pulmonary Embolism?â
American Kidney Fund: âHeart disease,â âTreatment of kidney failure.â
Circulation: “Anemia in Chronic Heart Failure,” “Thrombotic complications in heart failure.”
PubMed Health: “Liver.”
European Journal of Medical Research: “When the heart kills the liver: acute liver failure in congestive heart failure.”
Future Cardiology: “Muscle Wasting Is Associated With Reduced Exercise Capacity and Advanced Disease in Patients With Chronic Heart Failure.”
Can Anemia Affect My Weight
Having enough iron may also be a factor in weight issues. Studies have found overweight people might lose weight if they address low iron in the blood. You might experience unintentional weight loss along with anemia if you have other conditions, such as cancer. People who have had weight loss surgery might become anemic due to vitamin and mineral deficiencies.
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How Is Heart Failure Diagnosed
In addition to a complete medical history and physical examination, diagnostic procedures for heart failure may include some combination of the following:
chest X-ray: a process that produces pictures of internal tissues, bones and organs
echocardiogram : an ultrasound of the heart
electrocardiogram : wires taped to various parts of your body to create a graph of your hearts electrical rhythm
BNP testing: B-type natriuretic peptide is a hormone released from the ventricles in response to increased wall tension that occurs with heart failure. BNP levels rise as wall stress increases. BNP levels are useful in the rapid evaluation of heart failure. In general, the higher the BNP levels, the worse the heart failure.
Chest Pains And Palpitations
A rapid heartbeat and palpitations along with feelings of anxiety may be connected to a lack of oxygen in the blood.
A consistently rapid heart rate is not good for your heart or for the rest of your body. When theres a low level of oxygen in the blood, the heart works extra hard to compensate. This puts a lot of pressure on the heart, which can cause it to beat faster, irregularly, and experience pain.
Untreated anemia can exacerbate underlying cardiovascular issues. Extreme cases can lead to an enlarged heart, heart murmurs, or even heart failure.