Q: My grandfather (aged 84 years) is suffering from anaemia. His kidneys and bones have become weak. He has been suffering from diabetes for the past 25 years. He is being given blood every 15 to 21 days. He has also been prescribed injections like NeoRecormon. Is there any alternative in allopathy/alternate treatments that will enhance his natural blood generating capacity and be a long-lasting solution?

A:Anaemia is a condition in which the number of red blood cells or the amount of haemoglobin is below normal for age and sex of the individual. It is defined as a decrease in red blood cells (RBC) mass and is usually discovered and quantified by measurement of the RBC count, haemoglobin (Hb) concentration, and hematocrit (Hct). Anaemia is suggested in males with Hb levels less than 13.0 g/dl and in females with Hb levels less than 12.0 g/dl (less than 11.5 g/dl in pregnant women). It may be due to decreased production of red blood cells, blood loss (haemorrhage) or red cell breakdown (haemolysis). Formation of blood cells (haematopoiesis) depends on several factors like - the presence of stem cells in the bone marrow that are capable of differentiating and developing into mature blood cells; a supportive bone marrow environment for stem cell survival and functioning, and the presence of growth factors that control the division, differentiation and survival of blood cells. Any dysregulation results in anaemia. The red cells arise in the bone marrow under the influence of a hormone called erythropoietin produced by the kidneys. Since kidneys produce the hormone that is the primary driver of red cell production, renal disease leads to anaemia. The treatment of choice is recombinant human erythropoietin (rHuEPO). Prior to starting therapy, assessment of iron stores must be done (serum iron, transferrin & ferritin) and if deficient, iron supplementation is given. In case of mild renal failure (as in diabetics), weekly injections are given till haemoglobin rises to greater than 10 g/dl and then it is maintained at this level. If there is no response to erythropoietin in 4-8 weeks of weekly therapy, iron stores should be reevaluated. If they are adequate the dose is increased by 50% and continued for another 4-8 weeks.