Checking whether your treatment is working

The box below gives information about the blood tests you might need to have to check whether your treatment is working, and your specialist should discuss with you what test results would be ideal for you (these are called target levels). How often you have these tests will depend on your treatment and how severe your anaemia is.

Tests for checking if your anaemia treatment is working

Blood test

When you should have it

Target levels

Haemoglobin (Hb) levels

  • Every 2–4 weeks when you're starting ESA treatment

  • Every 1–3 months once your ESA treatment is settled

  • More often if your ESA dose has been changed recently

You and your anaemia specialist should discuss where this is done so that it is as convenient for you as possible

  • All people aged 2 years and over: 100 to 120 g per litre

  • Children under 2 years: 95 to 115 g per litre

Percentage of hypochromic red cells, reticulocyte haemoglobin content

  • Every 3 months

  • Every 1–3 months if you are receiving haemodialysisa

  • Hypochromic red cells: less than 6% (if you are on ESAs)

  • Reticulocyte haemoglobin content: more than 29 picograms

Below are the tests offered if 'percentage of hypochromic red cells' and 'reticulocyte haemoglobin content' are not available

Serum ferritin (if you are receiving iron) and transferrin saturation

  • Not within 1 week of having an iron infusionb

  • Serum ferritin every 1–3 months

  • Serum ferritin: more than 100 micrograms per litre

  • Transferrin saturation

    • Every 1–3 months if you are receiving haemodialysis

    • Every 3 months if you are going to have a kidney transplant before dialysis, or you are receiving peritoneal dialysisc

  • Transferrin saturation: more than 20%

a Haemodialysis or kidney dialysis – a procedure to remove fluid and waste products from the blood.

b Iron injection given using a drip or a machine.

c Peritoneal dialysis uses the patient's peritoneum (the thin membrane lining the inside of the abdomen) as a filter.

If ESAs aren't working

Some people continue to have low numbers of red blood cells despite having ESA treatment. This means there is less haemoglobin to carry oxygen around the body in the red blood cells. These people might need to continue on high doses of ESA to stay at their target haemoglobin level or if their haemoglobin level is low. If this happens to you, your anaemia specialist should try to find out what is causing it (for example, it might be happening because you're losing blood or there's another medical problem). If your doctor can't find anything else that could be causing it, the problem could be because of your kidney disease or the ESA treatment itself. Your anaemia specialist should discuss any other tests and treatment that might be needed if this seems to be the case.

Your doctor may refer you to a service that specialises in treating blood conditions to investigate why the ESAs aren't working. They are more likely to do this if they think you might have a blood disorder. Once you have been referred, one of the possible treatment options may be a blood transfusion. But before deciding whether to offer you a transfusion your doctor should take into account your symptoms, quality of life and what other conditions you have. They should discuss the risks and benefits of transfusion with you (or your family or carers, if appropriate).

If your ESAs aren't working and you are having regular transfusions, your anaemia specialist may ask you if you would like to stop your ESA treatment for a while to see if you still need it. After stopping the ESA, your anaemia specialist should check after 1 to 3 months to see if you need to go back onto ESA treatment.

Questions to ask about transfusions

  • What might a blood transfusion mean for me?

  • Why might I need a transfusion?

  • What are the risks of having a transfusion?

  • Are there any reasons why I shouldn't have a transfusion?

  • What are the advantages and disadvantages of having a transfusion?

  • Information Standard