Anemia

Diagnosis :

- In microcytic anemia: ferritin and transferrin saturation: important for the diagnosis of iron deficiency in heart failure.

Iron deficiency anemia due to gastrointestinal blood loss :
- Screening with a fecal occult blood test.
- If necessary, gastroscopy/colonoscopy (according to current guidelines for screening in the general population).
Consider renal anemia if there is also moderate to severe chronic renal insufficiency, without iron deficiency. If there are no deficiencies, subcutaneous injections of EPO can be considered through the nephrology consultation. However, studies with subcutaneous EPO showed no added value on the prognosis in patients with heart failure (HFrEF) but it can improve the symptoms of fatigue and exercise intolerance.
Consider an underlying hematological pathology as well if :
- Other disordered blood cells (for example anemia with leukopenia and/or thrombopenia).
- Low reticulocytes (indicating abnormally low production of red blood cells in the bone marrow).
- Signs of hemolysis (high LDH, low haptoglobin,…).

Treating the cause.
Intravenous therapy with iron (see: iron deficiency).
Subcutaneous injections of EPO as indicated by the treating nephrologist.
Transfusion (via admission or day hospital cardiology, gastroenterology, geriatrics, etc.)
It is best to aim for a hemoglobin of around 9 - 10 g/dl.