Skip to Main Content

ANEMIA

Population

  • Adults and children.

Recommendations

British Society of Gastroenterology 2011

  • Initial evaluation should include a complete blood count, including Hb and mean corpuscular volume, as well as a reticulocyte count, ferritin level, total iron-binding capacity, and transferrin saturation, permitting the calculation of a reticulocyte index and Mentzer index.

Comment

  1. Iron deficiency anemia (IDA) and anemia of chronic disease (ACD), sometimes called anemia of inflammation, are the two most common causes of anemia. ACD is often underrecognized, with some hospital-based studies in the United States estimating the prevalence as high as 70%.

ANEMIA, CHEMOTHERAPY ASSOCIATED

Population

  • Adults with cancer and anemia.

ASH 2019

Recommendations

  • Offer erythrocyte-stimulating agents (ESAs) to patients with chemotherapy-associated anemia whose cancer treatment is intended to cure and whose Hb has declined to <10 g/dL. RBC transfusion is also an option, depending on the severity of the anemia or clinical circumstances.

  • Do not offer ESAs to most patients with cancer not on chemotherapy who have anemia. It may be offered to patients with lower risk myelodysplastic syndromes and a serum erythropoietin <500 IU/L.

  • In patients with myeloma, non-Hodgkin lymphoma, or chronic lymphocytic leukemia (CLL), clinicians should observe the hematologic response to cancer treatment before considering an ESA.

  • Counsel patients on the thromboembolic risks associated with ESAs prior to initiation.

  • Epoetin beta and alfa, darbepoetin, and biosimilar epoetin alfa have equivalent safety and efficacy.

  • Discontinue ESAs if no response within 6–8 wk.

  • Consider iron replacement to improve Hb response and reduce RBC transfusions. See “Anemia of Chronic Disease” section for iron store assessment in inflammatory states.

TABLE I: COMMON CAUSES OF ANEMIA

Comment

  1. FDA-approved starting dose of epoetin is 150 U/kg 3 times/wk or 40,000 U weekly. For darbepoetin the dose is 2.25 µg/kg weekly or 500 µg every 3 wk subcutaneously.

ANEMIA, HEMOLYTIC (HA)

Population

  • Adults.

Recommendations

BSH 2016

...

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.