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Refractory anaemia,very low counts,works as a builder,has pacemaker,ulcerated leg after fall,treatment and prognosis?

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General & Family Physician
Practicing since : 2005
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Hello. My father aged 78 has been diagnosed with refractory anaemia, we are unsure of the form, however it appears that he may have had the condition for many years and despite very low counts ( the consultant is apparently suprised that he is still with us) he continues to work a couple of days a week as a builder. Please can you advise of the treatment options and possible prognosis, Dad has to return to hosp in 4 weeks when they will consider the need for a transfusion.
Additional information my father also has a pacemaker and long standing problems with an ulcerated leg following a fall 40 years ago. He is in other respects in good health, does not smoke or drink and is of slim build. He has been very fit and active throughout his life.
Thank you for your help. Heather.
Sun, 20 May 2012 in General Health
Answered by Dr. Prasad 2 hours later
Dear Healther,

Thanks for consulting me.

Anemia is a condition which is caused by set of causes ranging from nutritional problems to chronic infections to chronic medical disease such as renal disease to blood disorders to tumors and so on. Though I do agree with you that the anemia apparently may have been for a while, the probable cause is hard to predict without test reports.

The most common cause responsible for refractory anemia is iron deficiency which needs to be corrected via appropriate diet changes or iron supplements.

Now to answer your question (about his treatment options and possible prognosis); appropriate and valid answer to this question is possible after completion of tests alone - His treating hematologist after an examination may ask for a set of investigations starting with 'Complete Blood Counts' with Red blood indices' and 'Peripheral smear'. The results of this test will classify anemia accordingly as normocytic normochromic anemia / microcytic hypochromic anemia / macrocytic anemia. Each of these classes have separate list of causes.
The seperate causative factors will be diagnosed again by another set of test that include may reticulocyte counts, serum feritin levels, serum erythropoeitin levels, screening for tumours, special tests such as coomb's test, electrophoresis tests, genetic studies, bone marrow cytology and so on will be requested.

Treatment primarily consists of iron supplementation and blood transfusions. Apart from this other treatment depends on the cause - Erythropoeitin injections, treating possible infections, tumour treatments, bone marrow transplantation and so on.

To summarize, "it is too early to predict the possible cause and the prognosis of the condition. Treatment could be a short term or may run throughout his life. It could be possible that me may need repeated transfusions and surgical treatment such as bone marrow replacements, etc."

My apologize to you if you do not find my answers specific, but without reviewing his reports it is hard for even expert hematologist to predict the specific treatment plan and the possible prognosis.

Hope I have answered your query adequately. I suggest you to post the results of his reports to know more about his condition.

Awaiting your reply.


Above answer was peer-reviewed by
Follow-up: Refractory anaemia,very low counts,works as a builder,has pacemaker,ulcerated leg after fall,treatment and prognosis? 21 hours later
Thank you very much for your response. I think I have only one more question arising, and that is:
If my father is to be treated by blood transfusions, is there a limit to the number of transfusions which a person can safely receive. Obviously there is always a risk, however small, of cross infections such as HIV, Hepatitis, etc. But putting these risks to one side, is there any other fundamental reason for which a course of blood transfusions would be limited in number or duration?

I will not have the results of any clinical tests for a few weeks yet.

Once again, thank you for your advice.

Yours sincerely
Answered by Dr. Prasad 4 hours later

Thank you for following up.

The blood transfusion is deemed necessary if
1. Blood hemoglobin levels are less than or equal to 6 (severe anemia)
2. Symptoms of cardiac failure are noticed - breathing difficulty, limb swelling, tachycardia (increased heart rate) and drop in blood pressure are common symptoms that occur due to cardiac failure.
3. Hemoglobin levels between 6 to 10 may warrant blood transfusion, if clinicians feel the need (if there is an ongoing blood loss, his ability to withstand anemia is poor, if he feels that organ failure may be inevitable if anemia worsens, and other factor are taken into consideration).

It is obvious that these are the benefits of blood transfusion.

Now risks of blood transfusion are
1. As you have reported, chances of cross infection (though almost all blood bank screen the blood products for all possible infections)
2. Blood transfusion can precipitate high volume heart failure.
3. Above 65 years, in the presence of past cardio-pulmonary disease exists

Now to answer your question; "The number of blood transfusions which may be deemed necessary will be decided by the treating clinician / hematologist after considering the risks and benefits.
Considering your father's age and his past heart ailment, I wouldn't be subjecting him to multiple blood transfusions. I would consider transfusing blood only if it is absolutely required. I would prefer to limit the transfusions to not more than 2 per week."

Hope I have adequately answered your query. If you find my answer useful, then request you to accept it.

Wish you and your father good health!!!
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