Pumping Iron

January 23, 2006

New drugs and revamped guidelines are expected to usher in many changes in the treatment of anemia

At a glance

As many as 3.4 million people in the United States have been diagnosed with anemia, according to findings from the National Center for Health Statistics' survey in 1996, but the actual number is believed to be much higher. The Department of Health & Human Services also identified anemia as a significant public health concern in the Healthy People 2010 initiative and called for further review of the condition. Anemia is now recognized as a risk factor for the development of cardiovascular disease (CVD) in patients with chronic kidney disease (CKD).

Manufacturers have also discovered the large and growing market for anemia management products; thus, the pipeline contains several promising candidates poised for future Food & Drug Administration approval.

Anemia 101

Anemia occurs when hemoglobin (Hgb) and hematocrit (Hct) levels fall below normal. According to the National Kidney Foundation (NKF), patients on dialysis should be evaluated for anemia when their Hgb falls below 12 gm/dl or their Hct below 37% in adult males and postmenopausal women, and Hgb below 11 gm/dl or Hct less than 33% in premenopausal women.

"Anemia caused by chronic kidney disease is primarily due to a lack of erythropoietin secretion from damaged kidneys," said Wendy L. St. Peter, Pharm.D., FCCP, BCPS, associate professor at the University of Minnesota College of Pharmacy. Consequently, fewer RBCs are produced from the bone marrow and the ability of the blood to deliver oxygen is diminished. NKF estimates that 20 million Americans have CKD, and anemia is a common and early complication that worsens as CKD progresses.

Anemia due to blood loss is the most common type; it is believed to affect 10% to 20% of the world's population and can lead to iron deficiency anemia. Blood loss means less iron is retained in the body, resulting in inadequate levels of hemoglobin. Menstruation, pregnancy, and chronic bleeding from the gastrointestinal tract-caused by peptic ulcer, hemorrhoids, cancer, and parasitic infections-can all lead to iron deficiency anemia.