Therapie der chronischen Entzündungsanämie – Eisen, Bluttransfusionen oder Erythropoetin?

Abstract

The anaemia of chronic disease is a concomitant phenomenon of various chronic intectious, 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 100 μg/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 und 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. 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.