Chapter 33: Hematologic Disorders

ANEMIA

Population

• – Adults and children.

Recommendations

British Society of Gastroenterology 2011

• – Evaluate with complete blood count, including Hb and mean corpuscular volume, reticulocyte count, ferritin level, total iron-binding capacity, and transferrin saturation. Calculate 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%. See Table 33-1 for common causes of anemia.

ANEMIA, CHEMOTHERAPY ASSOCIATED

Population

• – Adults with cancer and anemia.

ASH 2019

Recommendations

• – Offer erythrocyte-stimulating agents (ESAs) if Hb <10 g/dL and curative intent. Consider RBC transfusion as alternative.

• – Do not offer ESAs to cancer patients with anemia who are not on chemotherapy who have anemia. Exception: 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), observe the response to treatment before considering an ESA.

• – Counsel patients on the thromboembolic risks associated with ESAs.

• – 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.

Source

• – Blood Adv. 2019;3(8):1197–1210.

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