This handout is for anaemia of chronic disease / anaemia of inflammation (incl. anaemia of ckd, malignancy, chronic infection, functional iron deficiency). Your care team identified this based on: low haemoglobin — normocytic (sometimes mildly microcytic) anaemia (weiss nejm 2019 pmid 31532961).
Other reasons your team may use this plan: anaemia in ckd on problem list (kdigo 2026 anaemia-in-ckd); ra / sle / ibd / chronic infection / malignancy / hf on problem list with anaemia (weiss nejm 2019 pmid 31532961); high/normal ferritin + low tsat pattern flagged on iron studies (weiss nejm 2005 pmid 15758012).
Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.
| Medication | Starting dose | How | When | What it does |
|---|---|---|---|---|
| treat_underlying_inflammatory_disease | — | — | — | TREAT THE CAUSE FIRST — controlling inflammation (DMARD/biologic for RA/SLE/IBD, antimicrobials for chronic infection, oncologic therapy, GDMT for HF) lowers hepcidin and frequently corrects the anaemia (Weiss NEJM 2019 PMID 31532961) |
| ferric carboxymaltose | 750 mg (≥50 kg) or weight-based | IV | two doses ≥7 days apart (per total iron deficit) | IV iron preferred when inflammation impairs oral absorption; AFFIRM-AHF showed FCM reduced HF hospitalisations (RR 0.74, 95% CI 0.58–0.94) in iron-deficient HFrEF (Ponikowski Lancet 2020 PMID 33197395) |
| ferric derisomaltose | 20 mg/kg (single high-dose infusion typical) | IV | single dose (repeat per deficit) | High single-dose IV iron repletion option; effective in inflammation-impaired absorption (KDIGO 2026 anaemia-in-CKD) |
| ferumoxytol | 510 mg | IV | two doses 3–8 days apart | IV iron alternative, validated in CKD-associated functional/absolute iron deficiency (KDIGO 2026 anaemia-in-CKD) |
| iron sucrose | 100–200 mg per session | IV | repeated sessions to total deficit | Established IV iron for haemodialysis-associated anaemia; per-session dosing fits HD schedule (KDIGO 2026; PIVOTAL strategy) |
| ferrous sulfate | 325 mg (65 mg elemental) | PO | once daily or alternate-day | Oral iron acceptable only when inflammation is mild (hepcidin-driven malabsorption blunts response in active inflammation); alternate-day dosing improves fractional absorption (Weiss NEJM 2019 PMID 31532961) |
| epoetin alfa | CKD: ~50 U/kg 1–3x/week or per protocol | SC | titrate to Hb target | ESA for CKD anaemia not normalising on iron (KDIGO 2026, individualised Hb ~10–11.5 g/dL) or chemo-induced anaemia with non-curative intent and Hb <10 (ASCO/ASH 2019 PMID 30969847) — NOT curative, requires thromboembolism + tumour-progression shared decision |
| darbepoetin alfa | CKD: 0.45 mcg/kg weekly or 0.75 mcg/kg q2wk | SC | weekly to q2–4 weeks | Long-acting ESA; comparator arm in ASCEND-ND (PMID 34739196); same Hb-ceiling and thrombosis caveats as epoetin (KDIGO 2026; ASCO/ASH 2019 PMID 30969847) |
| methoxy polyethylene glycol-epoetin beta | CKD: 0.6 mcg/kg q2wk or per protocol | SC | q2–4 weeks (monthly maintenance) | Continuous erythropoietin receptor activator — monthly maintenance option for CKD anaemia (KDIGO 2026 anaemia-in-CKD) |
| daprodustat | oral, per CKD/dialysis-status protocol | PO | once daily | Oral HIF-PHI; ASCEND-ND non-inferior to darbepoetin on Hb and MACE in non-dialysis CKD (PMID 34739196) and ASCEND-D in dialysis CKD (PMID 34739194); cardiovascular/thrombosis caveats apply, restricted to CKD anaemia |
| restrictive_red_cell_transfusion | — | — | — | Restrictive strategy — transfuse at Hb ~7 g/dL (8 g/dL with cardiac disease), single-unit then reassess; conditional lower-certainty in haematologic/oncologic adults (AABB 2023 PMID 37824153) |
Plan: Anaemia of chronic disease / inflammation management (IV iron + ESA + HIF-PHI + transfusion)
Contact your care team if any of the following happen:
Call 911 or go to the nearest emergency room right away if you have:
Interval review tied to underlying-disease control; periodic iron studies and CBC; re-evaluate ESA/HIF-PHI dose against the individualised Hb target; in elderly maintain a low threshold to re-investigate for occult malignancy/MDS if anaemia worsens or fails to track inflammation; patient education on adherence, transfusion-sparing goals, and red-flag symptoms (KDIGO 2026; Weiss NEJM 2019 PMID 31532961)
Guideline: KDIGO 2026 Anaemia in CKD + ASCO/ASH 2019 ESA in Cancer-Associated Anaemia + Weiss/Ganz/Goodnough NEJM 2019 Anaemia of Inflammation + AABB 2023 RBC Transfusion