What treatments are there for blood disorders?
What treatments are there for blood disorders?
Treatments vary depending on the type of disease, and can include simple observation, use of steroids and other immune-modulating therapies, transfusions or coagulation factor support, growth factor supplementation, chemotherapy and bone marrow transplantation. As with any medication, it is important to know how and when to take your medication according to your provider’s guidelines, and to have frequent blood tests, as ordered by your provider.
Anemia
- Autoimmune hemolytic anemia: When your body makes autoantibodies against your own red blood cells, you have a condition known as autoimmune hemolytic anemia. Steroids can suppress the immune system and interrupt the destruction of red blood cells. But you can’t take steroids indefinitely without causing long-term side effects such as osteoporosis. Most people respond to steroid treatment. If you relapse, your provider may try other agents such as intravenous immunoglobulin (IVIG), cyclophosphamide or cyclosporine. Your spleen may need to be removed.
- Chronic anemia: For chronic anemia, you may see improvement from treatment of the underlying disease (infection, arthritis, heart, lung or kidney disease). If that's not possible and your anemia is causing symptoms, a red blood cell transfusion may be necessary. Your healthcare provider may also prescribe a hormone (recombinant human erythropoietin). The erythropoietins are also useful in other types of anemia when there aren’t enough red blood cells in the bone marrow, such as chemotherapy-induced anemia, myelodysplastic syndrome and aplastic anemia. They are particularly useful in the anemia of kidney disease, which is caused by an underproduction of erythropoietin in certain specialized cells of the kidney.
- Nutritional deficiency anemia: For anemia caused by nutritional deficiencies, your healthcare provider may prescribe oral iron tablets, vitamin B12 injections or an oral folic acid.
- Sickle cell anemia: Sickle cell anemia can be tough to treat. If an underlying cause of a sickle cell crisis (such as infection) can be identified, prompt treatment can make the crisis less severe and get you feeling better faster. Managing a severe pain episode requires potent pain-relieving narcotic medications. Your provider may also order blood transfusions if you have severe anemia that impacts heart and lung function, or when you are going into surgery. Regular transfusion or exchange transfusion can also prevent recurrence of stroke in people with sickle cell disease. Unfortunately, chronic transfusion leads to problems with iron overload, which results in extra iron deposits in the liver, heart and other sites. This can cause problems with those organs. Your provider may use desferrioxamine or deferasirox (Exjade®) to help avoid these problems. Another drug, hydroxyurea, has been found to lessen the frequency and severity of sickle cell crises.
Low platelet count (thrombocytopenia)
Unlike anemia, there is no agent available that reliably increases the platelet count for conditions involving underproduction of platelets in the bone marrow. However, even a relatively low number of platelets may not require treatment if it does not cause life-threatening bleeding. For bone marrow conditions that result in severely low platelet counts or when severe thrombocytopenia and bleeding occur after chemotherapy, platelet transfusions must be given to either lessen the risk of bleeding or stop bleeding. Because transfused platelets only circulate for about 3-4 days and anti-platelet antibodies can develop upon repeated exposure to transfused cells, platelet transfusion is only used briefly to see you through a period of highest risk.
Bleeding disorders
In mild forms of hemophilia and in most types of von Willebrand disease, you may not be diagnosed until adulthood, when you have a pre-operative assessment for elective surgery that shows abnormal clotting times. Your surgery may be delayed until you can see a hematologist. If an underlying abnormality is found, you may be given a test dose of desmopressin, which causes an increase in proteins that help with clotting (factor VIII or von Willebrand factor) levels. If enough of an increase is demonstrated, then this agent can be used to support hemostasis during a minor surgical procedure. If not, or if it is a major operation (cardiac or brain surgery), factor VIII or von Willebrand factor concentrates must be given immediately before the procedure and continued for several days afterward.
Clotting disorders
Certain blood clotting (coagulation) disorders are inherited, but usually don't manifest themselves until later in life. Some clots can occur spontaneously or without obvious cause. But blood clots that develop after surgery or prolonged periods without moving are more common. No matter what the setting, the treatment is anticoagulant therapy. After certain types of surgery, such as orthopedic procedures on the lower extremities or surgery on the spine, your risk of developing a clot is high. Clinical trials have shown the benefit of giving anticoagulants (heparin or warfarin) to patients who have these surgeries to reduce the incidence of blood clots.
Anticoagulants also are used to treat established blood clots. Therapy consists of intravenous heparin, followed by oral warfarin. In simple blood clots, you may be able to self-administer medications at home. Usually anticoagulant therapy is continued for 3 to 6 months. If you have recurrent episodes of thrombosis, especially pulmonary emboli, or have laboratory markers of thrombophilia, your treatment may last longer and may be indefinite.