A Review of Advanced Anemia Management Practices in Developed Countries and the Existing Gaps in Pakistan

Abstract

Background: Anemia remains a major public health and clinical challenge, particularly in low- and middle-income countries where nutritional deficiency, infection, maternal health barriers, poverty, and limited healthcare infrastructure sustain a high disease burden. Developed healthcare systems have increasingly shifted from hemoglobin-based recognition of anemia toward biomarker-guided diagnosis, individualized therapy, intravenous iron use, erythropoiesis-stimulating agents, Patient Blood Management, and surveillance-based prevention. In Pakistan, however, anemia remains highly prevalent among women of reproductive age and children under five, while diagnostic and therapeutic practices remain constrained by limited laboratory capacity, fragmented care pathways, and inconsistent policy implementation. Objective: This structured narrative review aimed to compare advanced anemia management practices in developed healthcare systems with current diagnostic, therapeutic, preventive, and policy-related approaches in Pakistan, and to identify key implementation gaps relevant to national anemia control. Methods: A structured narrative review was conducted using literature from PubMed, MEDLINE, Cochrane Library, Scopus, and Google Scholar covering 2015–2025. Eligible sources included peer-reviewed studies, systematic reviews, clinical guidelines, national surveys, government reports, and public health documents addressing anemia diagnosis, iron profiling, intravenous iron therapy, erythropoiesis-stimulating agents, Patient Blood Management, screening, fortification, and policy implementation. Evidence was synthesized thematically across diagnostic approaches, therapeutic strategies, health-system integration, and public health interventions. Results: Approximately 80 records were initially screened. Developed countries demonstrated more advanced anemia care through ferritin, transferrin saturation, inflammatory markers, intravenous iron, ESA-guided chronic kidney disease management, PBM programs, preoperative anemia correction, and structured surveillance. Pakistan showed persistent gaps, including hemoglobin-centered diagnosis, limited ferritin/TSAT/CRP access, reliance on oral iron, restricted IV iron and ESA availability, weak PBM integration, and inconsistent monitoring of nutrition and maternal-child health policies. Conclusion: Pakistan’s anemia burden requires a coordinated national framework that strengthens diagnostic capacity, expands evidence-based treatment access, integrates PBM and maternal-child screening, and links public health policy with measurable surveillance and implementation outcomes