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Nathan Goodyear

Anemia in cancer - 0 views

annonc.oxfordjournals.org/...vii167.long

cancer anemia

shared by Nathan Goodyear on 30 Mar 15 - No Cached
  • Anemia is a frequent finding in cancer patients, occurring in >40% of cases
  • chemotherapy, the incidence of anemia may rise to 90%
  • Anemia exerts a negative influence on the quality of life
  • ...17 more annotations...
  • Anemia has also been identified as an adverse prognostic factor
  • mild (10 g/dl—normal), moderate (8–10 g/dl), severe (6.5–8 g/dl) and life threatening (<6.5 g/dl or unstable patient) anemia
  • anemia in cancer patients is often multifactorial.
  • Cancer itself can directly cause or exacerbate anemia either by suppressing hematopoiesis through bone marrow infiltration or production of cytokines that lead to iron sequestration, or by reduced red blood cell production
  • in inflammatory anemia, iron deficiency should be defined by a low transferrin saturation of <20%, ferritin levels of <100 ng/ml and a low reticulocyte hemoglobin concentration of <32 pg
  • anemia to thrombocytosis, as commonly seen in cancer patients
  • TNF-α inhibits hemoglobin production
  • treatment itself may be a major cause of anemia
  • Other cytokines, such as interleukin-6 (IL-6), IL-1 and interferon-γ, have also been shown to inhibit erythroid precursors in vitro [9], albeit to a lesser extent
  • In inflammation, from whatever cause, IL-6 induces the liver to produce hepcidin. Hepcidin decreases iron absorption from the bowel and blocks iron utilization in the bone marrow
  • Numerous in vitro studies have illustrated the central role of TNF-α in the pathogenesis of anemia
  • nephrotoxic effects of particular cytotoxic agents such as platinum salts can also lead to the persistence of anemia through reduced Epo production by the kidney
  • Currently two options are at the disposal of the clinician for the treatment of anemia in cancer patients: transfusion of packed red blood cells and the use of erythropoiesis-stimulating agents (ESAs)
  • The goal of the treatment is to relieve the symptoms of anemia such as fatigue and dyspnea.
  • Transfusion of 1 unit of packed red blood cells has been estimated to result in an increase in the hemoglobin level of 1 g/dl in a normal-sized adult
  • a higher mortality rate in patients receiving ESA treatment
  • Recent concerns regarding the risk of thromboembolism in patients treated with ESA have been corroborated by the meta-analyses conducted by Tonnelli and Bennett
  • Nathan Goodyear on 30 Mar 15
     
    Great review of anemia in Cancer:  1)  blood loss 2)  increased RBC loss 3)   decreased RBC production Cancer infiltration of marrow can reduce hematopoiesis.  Inflammatory cytokines can reduce hematopoiesis.  Inflammatory cytokines can block Fe absorption.  Chemo and radiation can cause anemia--particularily platinum based therapies.
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