After beginning treatment, it usually takes about 4 weeks before the number of functional red blood cells begins to increase. Epoietin alfa can effectively treat anemia due to reduced red blood cell production, but should not be used to treat hemolytic anemia or anemia due to blood loss or nutritional deficiencies. In cases where red blood cells are destroyed by an autoimmune reaction, immunosuppressive drugs such as prednisone may be effective. Another treatment that may be used is immunoglobulin plasmapheresis, a procedure in which harmful antibodies are removed from the blood. In some cases, blood transfusion may be necessary.
Healthcare providers prefer transfusions of packed red blood cells rather than whole blood.
If anemia is due to a temporary cause, such as blood loss due to injury, a transfusion can maintain a person until the cause is addressed and their own blood production system compensates for the loss. Potential detrimental effects of transfusions include hypersensitivity reactions and blood-borne infections. This is effective because the spleen is the primary site of red blood cell destruction. In persistent cases of aplastic anemia, a bone marrow transfer may be necessary to enable an individual to produce his or her own new red blood cells. Bone marrow transfers should come from a closely matched donor, preferably a sibling.