Anemia
From ShortGut - Wiki
Short gut can lead to risk of anemia, an abnormal reduction in red blood cells, due to problems absorbing iron, frequent blood draws for lab work, and compromised liver and spleen function.
Indicators and Symptoms
Two of the main indicators are low hematocrit (the percent of the blood made up of red blood cells) and low hemoglobin (which contains iron and carries oxygen to the tissues of the body), or low H&H.
Symptoms include low energy and pale appearance.
Treatments
- Do nothing: Some doctors, including Dr._Puder, prefer to let the H&H drop to a low level (e.g., low 20's for hematocrit) where it will often stabilize, rather than risk taxing the liver with any of the treatments below.
- Give oral iron drops: These may take a couple months before effects are seen. We stopped Max_Munakata's dose of .6cc/day because his ALT/AST were rising after we started Epogen (see below), suggesting liver problems, and it wasn't clear the oral iron ever helped his H&H. His ALT/AST subsequently improved, but other factors may have helped (e.g., Omega-3/fish_oil_supplements and reduction in TPN).
- Iron infusions into the blood: These are first administered in the hospital, to check for any serious side effects (including hives, severe allergic reactions, ?), but can then be administered at home if all goes well. Some hospitals seem reluctant to do these infusions due to a potential increase in risk of line infections, since bacteria like iron.
- Blood transfusions: These can raise H&H, but come with risks such as undetected pathogens from the blood supply and the development of antibodies if the same donor is used repeatedly.
- Recombinant Human Erythropoietin (e.g., Aranesp, Epogen): This acts like the hormone erythropoietin to stimulate the bone marrow to increase production of red blood cells. Iron stores should be good before trying this treatment, and additional iron (e.g., via oral iron drops) may be recommended. Some hospitals check whether natural erythropoietin levels are low before attempting this treatment. In contrast, Denver Children's says that the treatment can help anemia even when erythropoietin levels are normal. This treatment is most effective as a subcutaneous shot, and is usually tried that way first, w/the possibility of following up with IV infusions later if the shots are effective. Aranesp is newer and given only once every other week, compared to 3x per week with Epogen. Epogen normalized Max_Munakata's H&H for the first time ever, which blood transfusions and oral iron alone hadn't done. However, it may have taxed his liver (as indicated by increased ALT/AST) and caused nausea that lasted 5 weeks after the final shot, and giving a month of shots was not fun.
