variants of therapy of an anaemia at chronic illnesses and their efficiency

Substantiation for treatment AHB is that the anaemia is one of independent factors of an invalidism at patients with chronic diseases. Possibly, improvement on an anaemia after effective therapy of a basic disease can play an independent role in improvement of a physical condition of the patient [19].

Besides, the anaemia at chronic illnesses associates with more poor quality of a life, both at children, and at adults [63,244].

The best way of treatment of a rhematoid anaemia - realisation of the system control over disease with use synthetic or biological illness-modifying of antirheumatic preparations (Methotrexatum, antagonists FNO, rituksimab, abatatsept and totsilizumab) [24,50,54,108,127,135,230]. In cases when basic disease therapy is impossible, use of alternative methods of treatment is necessary. The generalised data of three randomizirovannyh researches of therapy RA by a combination of preparations infliksimab-Methotrexatum have shown rising of level of haemoglobin more than on 10 g/l at 40 % of patients and normalisation of level of haemoglobin at 43 % [230]. In research totsilizumaba at therapy RA, essential rising of level of haemoglobin at patients with an anaemia and insignificant augmentation of haemoglobin at patients without an anaemia became perceptible. At patients with an anaemia, receiving totsilizumab haemoglobin level was enlarged by 17 g/l, in comparison with 2 g/l in group platsebo, already on 2nd week from the beginning of therapy [127].

Transfusion therapy. The hemotransfusion is used as a fast and effective therapeutic intervention. Transfusions are especially necessary in case of a serious or extremely serious anaemia, and also at a proceeding bleeding. Hemotransfusions were assotsiirovany with rising of survival rate at patients with a warm pathology, but transfusions also were assotsiirovany with development multiorgan
Failures and mortality rising in critical cases [14,78]. Whether modulate hemotransfusions immune system, causing clinically significant by-effects, still it is not defined. Besides, frequent transfusions lead to an overload of an organism iron and to iron accumulation in organs and tissues and to development of multiorgan insufficiency [58,143,205,238,242].

Ferroterapija. Oral iron is badly acquired because of absorption depression in XiI-perstnoj to an intestine. Only the part of the soaked up iron will reach erythrogenesis sites, owing to redistribution of the iron induced by cytokines which refer iron to cells of reticuloendothelial system [12,53].

Besides, treatment by iron preparations for patients with AHB, is disputable. Iron - the nutrient necessary for proliferating cells. And absorption of iron from microorganisms or cells of a tumour reticuloendothelial system as believe, is potentially effective for growth suppression patogenov [243]. In researches it is shown, that at the patients receiving a hemodialysis and iron preparations parenteralno, with saturation of a transferrin more than 20 % and level of a ferritin more than 100 ng/ml, risk of development of bacteriemic infections authentically above [132]. Besides, treatment by iron preparations in the conditions of long-term immune activation promotes formation of high-toxic hydroxylic radicals which can lead to damage of tissues and endothelium dysfunction, and augmentation of risk of acute cardiovascular conditions [140,209,243].

On the other hand, treatment by iron preparations can render positive effects.

Inhibiting formation FNO, ferroterapija can reduce activity of a pseudorheumatism or an end-stage of diseases of kidneys [55,56]. Besides, patients with inflammatory diseases of an intestine well answer therapy by parenteral iron by rising of level of haemoglobin [183].

In addition to the absolute deficiency of iron accompanying AHB, functional deficiency of iron develops at an intensive erythrogenesis against therapy EPO and is shown by depression of saturation of a transferrin and a ferritin to 50 - 75 % from norm [30,79]. Parenteral iron can be prescribed for rising of a speed of response to therapy EPO at patients with the oncologic diseases receiving chemotherapy and at patients on a chronic dialysis [128,168].

On the basis of last data, patients with AHB and absolute deficiency of iron should receive therapy by iron preparations [128,168,235,251]. Iron appointment should be surveyed at the patients, not answering therapy EPO because of functional deficiency of iron. In these cases iron, most possibly, is used eritronom, rather than patogenami, that is shown by rising of level of haemoglobin without visible augmentation of number of infectious complications [128,132]. However, therapy by iron preparations is not recommended now to patients with AHB, which have high or normal level of a ferritin (nearby 100 ng/ml), because of a possible failure in this situation. Careful studying of potentially harmful influence of iron at patients with various forms of an anaemia of chronic diseases on - former are necessary [27,28,140,209,243,246].

Treatment by erythropoetins-excitants (rekombinantnyj EPO). The special place repo occupies in therapy of patients with chronic renal insufficiency, being a choice preparation. Also its use at the oncologic patients receiving mielosupressivnuju therapy [234] is effective.

In researches of 30 patients with the rhematoid anaemia, receiving repo from which 22 had functional deficiency of iron and also received iron preparations intravenously, increase of an average level of haemoglobin about 107 g/l to 132 g/l on the average in 9 weeks has been shown. Depression of activity RA, augmentation of an animal force and reduction of the general delicacy [56] besides, became perceptible.
In other double blind platsebo controllable research at 70 patients with RA and AHB it has been shown, that therapy repo improves quality of a life and raises haemoglobin level on the average on 22 g/l on 52 week (in comparison with absence of effect in group platsebo). It is considered, that therapy EPO raises quality of a life of patients with a pseudorheumatism and AHB [193] However, the data saying are published, that the rhematoid anaemia can be refrakterna to therapy repo, even in high doses, practically in 80 % of cases [191].

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Scientific source EGOROV Andrey Sergeevich. THE GEPSIDIN-INTERLEUKIN-6 SYSTEM AS A FACTOR FOR MANAGING THE COURSE OF ANEMIA IN CHRONIC ARTHRITIS IN CHILDREN DISSERTATION for the degree of candidate of medical sciences. St. Petersburg - 2016. 2016

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