Anemia in cancer

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Episode 11:

John A. Glaspy, MD, of the University of California, Los Angeles joins Blood & Cancer host, David Henry, MD, to discuss treatment of anemia in cancer patients, specifically chemotherapy-induced anemia.

In this week’s Clinical Correlation, Ilana Yurkiewicz, MD, poses the question, is there such a thing as well placed apathy when it comes to coping with cancer? Dr. Yurkiewicz has a column at MDedge, which you can find by clicking here.

Show notes

By Emily Bryer, DO, resident in the department of internal medicine, University of Pennsylvania

• Hemoglobin is associated with quality of life and functional status, and quality of life improves continuously as hemoglobin rises from low (8 g/dL) to normal (12 g/dL) levels.
• The complete workup of anemia involves reticulocyte count, iron studies, folate, B12, peripheral smear, and creatinine.
• Anemia is a consequence of 1) cancer and 2) chemotherapy
  • In patients with malignancy, the inflammatory state results in iron-restricted erythropoiesis, so patients may be functionally iron deficient even if their iron stores are replete.
• How do we treat anemia in cancer?
  
  • Blood transfusion to rapidly improve hemoglobin
  • Intravenous iron, if iron deficient
  • Erythrocyte stimulating agents (ESA), if iron stores are replete. (Although IV iron augments ESA response in all cancer studies reported so far.)
    
    • Risks associated with blood transfusion: Infection, transfusion-related-lung-injury, reactions to mismatched or well-matched blood, and iron overload (specifically in myelodysplastic syndrome).
  • Recent FDA-mandated studies in anemic metastatic breast and non-small-cell lung cancer patients have demonstrated that there is no difference in survival among patients who receive ESA or placebo to treat their cancer/chemotherapy-associated anemia.
  • HIF-1-alpha (hypoxia-inducible-factor) is a transcription factor produced in response to hypoxia.
    
    • New class of drugs stabilizing HIF can result in both an increase in erythropoiesis and a decrease in hepcidin.

References

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4. Cochrane Database Syst Rev.2016 Feb 4;2:CD009624.
5. International Journal of Clinical Transfusion Medicine. 2018;6:21-31.