Chapter 7: Hematologic Disorders

ANEMIA

Management

Adults and Children

Recommendations from

►British Society of Gastroenterology 2011

• –Evaluate with complete blood count, including Hb and mean corpuscular volume (MCV), reticulocyte count, ferritin level, total iron-binding capacity, and transferrin saturation. Calculate a reticulocyte index and Mentzer index.

ANEMIA, CHEMOTHERAPY ASSOCIATED

Management

Adults

Recommendations from

►American Society of Hematology (ASH) 2019

• –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. 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, 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 there is 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.

ANEMIA, HEMOLYTIC (HA)

Management

Adults

Recommendations from

►BSH 2016

Evaluation

• –Diagnose when there is:

  • Evidence of hemolysis (anemia, jaundice, ...