Red blood cell disorders

Disorders of red blood cells may be due to reduced or excessive production in the bone marrow, premature cell destruction (haemolysis) or loss from the circulation. A precise diagnosis must be made from the blood count, blood film, biochemistry and/or bone marrow examination so that appropriate therapy can be instituted. Anaemia due to a haematinic deficiency can be treated with specific replacement therapy (e.g. iron, vitamin B 12 or folic acid) along with management of the underlying cause. Other secondary anaemias may benefit from haemopoietic growth factor therapy such as erythropoiesis-stimulating agents (e.g. for chronic renal disease), immunosuppression (e.g. for autoimmune haemolytic or aplastic anaemia) or avoidance of specific drugs (e.g. sulfonamides or antibiotics). Inherited disorders of red cells (e.g. haemoglobinopathies) may require specific drug therapy (e.g. hydroxycarbamide for sickle cell disease), folate supplementation and blood transfusion. Over-production of red cells, as in polycythaemia vera, is managed by venesection and, for some patients, suppressing marrow erythropoiesis.