Management of Severe Anaemia

Immediate Transfusion Strategy

• The American Society of Hematology recommends transfusing 2-3 units of packed red blood cells immediately for patients with hemoglobin <7 g/dL or those with severe symptoms at any hemoglobin level, with each unit increasing hemoglobin by approximately 1 g/dL 1, 2
• For stable, non-cardiac patients, the target hemoglobin is 7-8 g/dL as the initial goal, according to the American College of Physicians 3, 1

Concurrent Diagnostic Workup

• The American College of Emergency Physicians states that treatment and diagnosis must proceed simultaneously, and transfusion should not be delayed while awaiting diagnostic results 2
• A complete blood count with reticulocyte count is essential, with a reticulocyte count >10 × 10⁹/L indicating regenerative anaemia, as recommended by the American Society of Hematology 1

Iron Therapy

• The European Society for Medical Oncology recommends administering intravenous iron for both absolute and functional iron deficiency, with oral iron having limited efficacy in severe anaemia 5
• For absolute iron deficiency (ferritin <100 ng/mL), 1000 mg IV iron should be given as a single or multiple doses according to product labeling, as suggested by the American Society of Clinical Oncology 5

Supportive Measures

• The Society of Critical Care Medicine recommends supplemental oxygen for respiratory distress with continuous oxygen saturation monitoring, and urinary catheter to monitor hourly urine output (target >30 mL/h) 1
• Folic acid supplementation of 1 mg daily is recommended by the American College of Gastroenterology 3

Special Population: Immune Checkpoint Inhibitor-Related Anaemia

• The National Comprehensive Cancer Network recommends permanently discontinuing checkpoint inhibitor if severe anaemia develops in patients on immune checkpoint inhibitors (Grade 3-4), with immediate hematology consultation and prednisone 1-2 mg/kg/day 3