Anemia Diagnosis and Treatment
Definition and Classification
- The American Society of Clinical Oncology and the National Comprehensive Cancer Network define anemia as a reduction in hemoglobin concentration, red cell count, or packed cell volume below normal levels, with severity classified as mild, moderate, or severe, according to the Annals of Oncology 1, 2
- Moderate anemia is defined as hemoglobin ≤9.9 g/dL and ≥8.0 g/dL, and severe anemia is defined as hemoglobin <8.0 g/dL, as stated in the Annals of Oncology 1, 3
Causes of Anemia
- Bone marrow disorders, such as bone marrow infiltration by cancer, can cause anemia, as reported in the Annals of Oncology and the Journal of the National Comprehensive Cancer Network 1, 2, 4
- Chronic conditions, including anemia of chronic disease/inflammation and renal insufficiency, can also cause anemia, according to the Annals of Oncology and the American Journal of Hematology 1, 2, 4
- Hemolytic anemias, such as autoimmune hemolytic anemia and drug-induced hemolysis, can cause anemia, as stated in the Annals of Oncology and the Journal of the National Comprehensive Cancer Network 1, 2
Diagnostic Approach
- The initial evaluation of anemia should include a complete blood count with reticulocyte count, peripheral blood smear examination, iron studies, and vitamin B12 and folate levels, as recommended by the Annals of Oncology and the Journal of the National Comprehensive Cancer Network 1, 2
- Special tests, such as Coombs testing and endogenous erythropoietin levels, may be necessary in certain cases, according to the Annals of Oncology and the Journal of the National Comprehensive Cancer Network 1, 2
Treatment Approaches
- The American Journal of Hematology recommends treating underlying causes of anemia, such as iron deficiency and vitamin deficiencies, with oral iron supplementation and vitamin B12 supplementation 2, 4
- Erythropoiesis-stimulating agents (ESAs) may be used to treat chemotherapy-induced anemia, but with caution due to increased risk of thromboembolism and cardiovascular events, as reported in the Annals of Oncology and the American Journal of Hematology 1, 3, 4
- Blood transfusions may be necessary for severe symptomatic anemia or when rapid correction is needed, but with consideration of risks, including iron overload and infection transmission, as stated in the Journal of the National Comprehensive Cancer Network and the Annals of Oncology 2, 3