Sections View Full Chapter Figures Tables Videos Full Chapter Figures Tables Videos Supplementary 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 ++ 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 Graphic Jump LocationTABLE I: COMMON CAUSES OF ANEMIAView Table|Favorite Table|Download (.pdf) TABLE I: COMMON CAUSES OF ANEMIA Cause MCV Ferritin Level RDW Hb Electrophoresis Iron/TIBC Mentzer Indexa Iron deficiency anemia (IDA) Low <30 High Normal <10% >13 Anemia of chronic disease (ACD) Normal/Decreased High Normal/High Normal >15% >13 IDA + ACD Normal <100 High Normal <20% >13 Beta thalassemia Low Normal Normal ↑A2, F hemoglobin ∼20% <13 Alpha thalassemia Low Normal Normal Normal ∼20% <13 Hemoglobin E Low Normal Normal ↑HgbE ∼20% <13 B12/Folate deficiency High Normal High Normal Normal <13 aMentzer index = MCV divided by red blood cell number (RBC) in millions. RDW, red cell distribution of width; TIBC, total iron binding capacity. ++ Comment ++ 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... GET ACCESS TO THIS RESOURCE Sign In Username Error: Please enter User Name Password Error: Please enter Password Forgot Username? Forgot Password? Sign in via OpenAthens Sign in via Shibboleth Get Free Access Through Your Institution Contact your institution's library to ask if they subscribe to McGraw-Hill Medical Products. Access My Subscription GET ACCESS TO THIS RESOURCE Subscription Options Pay Per View Timed Access to all of AccessMedicine 24 Hour $34.95 (USD) Buy Now 48 Hour $54.95 (USD) Buy Now Best Value AccessMedicine Full Site: One-Year Individual Subscription $995 USD Buy Now View All Subscription Options