Management of Anemia

Initial Assessment and Source Identification

Gastrointestinal bleeding is the most common cause of gradual Hb/Hct decline in adults, according to the American College of Critical Care Medicine 1
The American College of Critical Care Medicine recommends performing fecal occult blood testing and considering endoscopy based on risk factors 2
The American College of Obstetricians and Gynecologists defines anemia in pregnancy as Hb <11.0 g/dL in the first trimester, Hb <10.5 g/dL in the second trimester, and Hb <11.0 g/dL in the third trimester 3

The National Kidney Foundation defines iron deficiency as TSAT <20% and ferritin <100 ng/mL in chronic kidney disease patients 4
The American College of Critical Care Medicine states that in general populations, lower thresholds apply for iron deficiency, but the principle remains the same 5
The American Association for the Study of Liver Diseases recommends checking reticulocyte count, LDH, haptoglobin, and peripheral smear to evaluate for hemolysis and bone marrow disorders 6

The American College of Critical Care Medicine recommends avoiding reflexive transfusion based solely on Hb/Hct values, and using the same transfusion threshold as other ICU patients in critically ill patients without traumatic brain injury 1, 2, 5
The American College of Critical Care Medicine states that RBC transfusions in TBI patients are associated with two-fold increased mortality and three-fold increased complication rate 2
The American College of Critical Care Medicine recommends that the optimal Hct or Hb concentration required to sustain hemostasis in massively bleeding patients remains unclear 1

The National Kidney Foundation recommends administering at least 200 mg elemental iron daily for adults with iron deficiency anemia 4
The National Kidney Foundation recommends targeting TSAT of 20% and ferritin of 100 ng/mL to achieve and maintain Hgb 11-12 g/dL 4
The American Association for the Study of Liver Diseases recommends phlebotomy as the mainstay of treatment for hemochromatosis with elevated iron stores, removing one unit weekly or twice weekly as tolerated 6

The American College of Obstetricians and Gynecologists recommends adjusting hemoglobin cutoffs upward by 0.3-0.7 g/dL depending on smoking intensity when screening for anemia 7
The American College of Obstetricians and Gynecologists recommends adjusting Hb values upward for women living above 3,000 feet 3

The National Kidney Foundation recommends checking Hb/Hct every 1-2 weeks during active investigation or treatment adjustment, and every 3 months once stable at target 4
The National Kidney Foundation recommends monitoring every 3-6 months in CKD patients not on erythropoietin with TSAT <20% and ferritin <100 ng/mL 4