Here is an overview on approaches to treatment for different kinds of anemia, including aplastic anemia, sickle cell anemia, iron deficiency anemia, anemia of inflammation and chronic disease, and pernicious anemia.
Aplastic Anemia Treatments
Because aplastic anemia is a blood disorder in which the bone marrow in your body doesn’t produce enough healthy blood cells — often referred to as bone marrow failure — treatment involves increasing the number of healthy cells in your blood, so that you experience fewer symptoms.
Still, your doctor may only recommend treatment in severe cases of aplastic anemia, when the condition is getting worse or causing life-threatening symptoms. Oftentimes, treatment is not needed for mild to moderate aplastic anemia. (1)
Treating Aplastic Anemia
The following are treatment options for aplastic anemia: (1)
- Growth factors, both naturally occurring or man-made, which are hormones that stimulate bone marrow to make blood cells
- Antibiotics to prevent and treat infections
- Immunosuppressive drug therapy to keep your immune system from attacking your bone marrow
- Blood transfusions to restore blood cell counts to normal levels
- Iron chelation therapy for those with too much iron caused by red blood cell transfusions
- Blood and bone marrow stem cell transplants
Short-term incidences of aplastic anemia caused by medication, radiation, infectious mononucleosis, or pregnancy are usually treatable. Note that if you develop aplastic anemia during pregnancy, you may develop it again with other pregnancies. (2)
In severe cases, aplastic anemia can be deadly. The five-year survival, on average, is greater than 75 percent for patients who undergo bone marrow transplant from a suitable donor. But rates can vary depending on the patient’s age, disease severity, and other factors. (2)
If bone marrow transplant is not available or recommended, immunosuppressive therapy has improved outcomes with new regimens. For example, a 2022 report on a recent trial showed partial or complete responses between 41 and 68 percent at six months. However, up to 50 percent of patients who only receive immunotherapy relapse or develop other blood-forming malignancies or disorders.
Sickle Cell Anemia Treatments
Symptoms of sickle cell anemia typically start after the fifth or sixth month of life. Common signs and symptoms include:
- Swollen hands and feet, particularly in babies
- Frequent infections
- Fatigue and weakness
- Episodes of pain, called sickle cell crises, which occur when sickled red blood cells block blood flow to the limbs and organs
Improved treatments have given a better outlet for people with sickle cell anemia. As few as 40 years ago, almost 15 percent of children born with sickle cell anemia died before age 2, and many more died as teens. (3)
Now, because of improved treatments and care, people who have sickle cell anemia are living into their forties, fifties, or longer.
The only possible way to cure sickle cell anemia is with a successful bone marrow transplant, also referred to as stem cell transplant. Still, transplants are often only performed on children under age 16, since possible risks increase with age.
Still, risks from transplants are high for children, too. Other treatment options include the following. (4)
Medication for Treating Sickle Cell Anemia in Children
Antibiotics, such as penicillin, may be given to kids from about 2 months old until they are age 5 or older. The antibiotic can help prevent serious infections that could cause death in children, such as pneumonia.
Your doctor may prescribe bone marrow–suppressive drugs, such as hydroxyurea (Hydrea), which can help reduce the frequency of painful crises and avoid the need for blood transfusions and hospitalizations. While research is ongoing to determine the benefits and risks of long-term use of hydroxyurea, it is thought that the medication helps stimulate production of a type of hemoglobin in newborns that helps prevent the formation of sickle cells. (4) But it puts you at risk of getting infections, and if taken for a long time, it may cause problems as you age.
Other medication options include glutamine (Endari), an oral powder, and crizanlizumab (Adakveo), an injectable, both of which focus on reducing the severity and frequency of pain; and voxelotor (Oxbryta), which can lower the risk of anemia in people with sickle cell. (4)
Blood transfusions may also be given to help with sickle cell crises and lower your risk of having a stroke
Drinking a lot of water and not becoming physically exerted are lifestyle changes that can also help with symptoms.
Iron Deficiency Anemia Treatments
It takes time to treat iron deficiency anemia, and you may need to try several different treatments to find one that works best for you.
Your doctor may recommend:
Iron Supplements These prescribed and over-the-counter drugs can be taken in pill or liquid form (if needed for babies and kids). It can take months for iron supplements to begin making a difference in your body.
Your doctor will give you specific instructions on how to take the supplements to ensure that your body absorbs the iron properly.
Your doctor may suggest taking them on an empty stomach or with vitamin C. You may also need to avoid taking antacids when taking iron supplements.
Treating Underlying Causes When diet and supplements aren’t enough to treat iron deficiency anemia, your doctor may treat certain underlying causes of your iron deficiency, if they’re known. These treatments may include:
- Medication, such as oral contraceptives, to lighten your menstrual periods
- Antibiotics or other drugs for peptic ulcers
- Surgery to remove a bleeding polyp, tumor, or fibroid
If your condition is severe, you may need to receive iron therapy intravenously (by IV) or by having iron injected into a muscle. This is usually done if you need iron long-term or can’t take iron supplements orally. (5,6)
If your anemia puts you at risk for heart problems or other complications, you may need a blood transfusion.
Anemia of Inflammation or Chronic Disease Treatment
Oftentimes, doctors will treat the underlying condition that is causing anemia due to inflammation or chronic disease (AI/ACD). As the disease wanes, so will the anemia. For instance, if infection is causing the anemia, antibiotics prescribed for the infection may take care of the anemia once the infection clears. The same goes for anti-inflammatory medication prescribed for rheumatoid arthritis or irritable bowel disease. (7)
With that said, it is becoming more common for doctors to directly treat AI/ACD. Your doctor might try to stimulate production of red blood cells through the use of:
- Drugs that prompt production of erythropoietin
- Synthetic or genetically engineered forms of erythropoietin
- Injections of iron, vitamin B12, or folic acid supplements
In severe cases, you may need a blood transfusion or drug treatment to replenish your red blood cell count. But more research is needed to determine the benefits and risks of these forms of therapy for AI/ACD, because in some studies people who received these treatments have done worse than those who didn’t have them. (8)
Pernicious Anemia Treatment
While pernicious anemia was often deadly in the past, before vitamin B12 treatments existed, today it is fairly treatable with vitamin B12 supplements or shots. If you are not treated, you can develop serious health issues that may be permanent, including those affecting your heart, nerves, and other areas of the body.
The treatment you receive may need to last your whole life, but with proper treatment you can live a normal life.
Treating Mild or Moderate Pernicious Anemia
For mild or moderate pernicious anemia, your doctor may suggest large doses of vitamin B12 pills, or B12 nose gel and spray if you have difficulty swallowing pills.
With severe pernicious anemia, shots may be your best treatment. Oftentimes, shots are given in a muscle daily or weekly until your blood reaches a desired level of vitamin B12. At this point, you may get a shot monthly.
If the reason for your anemia is not related to lack of intrinsic factor, your doctor may try to treat what’s causing the condition. For instance, if you have a condition that doesn’t allow your body to absorb vitamin B12, your doctor may prescribe medication to treat that condition.
On the other hand, if medicines are the cause of your pernicious anemia, your doctor may adjust your medication accordingly. (9)
Once you begin treatment, you may feel better within a few days. Until your condition does improve, you may need to refrain from a lot of physical activity.