IM9.10-17 | Anaemia Treatment Prevention and Transfusion — Summary & Reflection

KEY TAKEAWAYS

Anaemia management is cause-specific — matching the treatment to the mechanism is the foundational principle.

Replacement therapy:
- IDA: Oral ferrous sulphate 200 mg (65 mg elemental iron) with vitamin C, away from tea and antacids; 3 months after Hb normalisation to replenish stores. Parenteral iron (ferric carboxymaltose, iron sucrose) for malabsorption, intolerance, or rapid repletion need; dose by Ganzoni formula. Expected Hb rise: 1–2 g/dL per 2–3 weeks.
- B12 deficiency: IM hydroxocobalamin 1000 µg loading (daily × 7 days, weekly × 4 weeks, monthly for life if absorptive cause); high-dose oral B12 if dietary cause only. Monitor for hypokalaemia during treatment. Never give folate alone without excluding B12 deficiency.
- Folate deficiency: Oral folic acid 5 mg/day for 4 months. Periconceptional folic acid (400 µg/day or 5 mg in high-risk women) prevents neural tube defects.

National programmes: AMB-WIFS: weekly IFA (100 mg elemental iron + 500 µg folate) for adolescents year-round via schools. Antenatal IFA: daily IFA throughout pregnancy and 180 days postpartum. Biannual deworming with albendazole 400 mg.

Blood transfusion:
- Indications: Hb <7 g/dL in stable patients; <8 g/dL with cardiovascular disease; haemodynamic instability from acute haemorrhage regardless of Hb.
- Components: PRBC (red cell replacement), FFP (coagulopathy), platelets (thrombocytopaenia with bleeding or prophylactic <10,000), cryoprecipitate (hypofibrinogenaemia, haemophilia A).
- Pretransfusion: ABO/RhD group and crossmatch; bedside identity check (3 identifiers × 2 personnel); vital signs; slow start with 15-minute observation.
- Adverse reactions: AHTR (ABO incompatibility — stop immediately, supportive care, report); FNHTR (common, paracetamol, leucodepleted blood); TRALI (respiratory distress within 6 hours, supportive); TACO (pulmonary oedema, frusemide).

Specialist referral: IDA unresponsive to iron (gastroenterology or haematology); B12 anaemia with dysplastic smear (haematology); suspected aplastic anaemia or haematological malignancy (haematology urgent); sickle cell/thalassaemia (specialist haematology); AIHA steroid-refractory; anaemia of CKD requiring ESA (nephrology).

REFLECT

Reflect on the two scenarios that bookended this module — the woman with Hb 4.8 g/dL from chronic IDA who was about to be transfused, and the woman who was discharged with iron tablets she did not understand and therefore did not take. Both represent treatment failures, but of opposite kinds: one from over-medicalisation (inappropriate transfusion), the other from under-communication (failed patient engagement). Think about what you would say to the patient with Hb 4.8 g/dL to explain why you are choosing parenteral iron over transfusion — and what you would specifically tell her about the iron tablets to prevent the compliance failure that brought her to this severe state in the first place. Effective anaemia management requires both the clinical reasoning to select the right treatment and the communication skills to ensure the patient actually receives it.