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Blood & Cancer

71 EpisodesProduced by MDedge Hematology OncologyWebsite

Interview-style hematology/oncology podcast from MDedge Hematology-Oncology. The show is hosted by Dr. David Henry with Pearls from Dr. Ilana Yurkiewicz for clinical hematology and oncology health care professionals. The information in this podcast is provided for informational and educational purpo… read more

27:28

Anemia in cancer

 

You can contact Blood & Cancer at podcasts@mdedge.com and you can follow MDedge Hematology Oncology on Twitter @MDedgeHemOnc.

Episode 11:

Blood & Cancer host David Henry, MD, welcomes John Glaspy, MD, to talk about anemia in cancer. And in today's Clinical Correlation, Ilana Yurkiewicz, MD, talks apathy. 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

 

  1. 2010 Dec 2;116(23):4754-61.
  2. Cancer Metastasis Rev.2007 Jun;26(2):341-52.
  3. Support Care Cancer.2006 Dec;14(12):1184-94.
  4. Cochrane Database Syst Rev.2016 Feb 4;2:CD009624.
  5. International Journal of Clinical Transfusion Medicine. 2018;6:21-31.

 

 

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