Guidelines for the Use of Erythropoietic Proteins in Anaemic Patients with Cancer

Anaemia is a frequent finding in cancer patients and should be carefully assessed. Additional causes of anaemia such as iron deficiency, bleeding, nutritional defects or haemolysis should be corrected prior to erythropoietic protein therapy. The following recommendations are related to adult cancer patients with solid tumours or haematological malignancies:

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Diagnosis of Iron Deficiency Anemia (IDA)

The diagnosis of Iron Deficiency Anemia (IDA) requires that a patient be anemic and show laboratory evidence of iron deficiency. Red blood cells in IDA are usually described as being microcytic (i.e., mean corpuscular volume less than 80 um3 [80 fL]) and hypochromic, however the manifestation of iron deficiency occurs in several stages.

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Diagnosis of Autoimmune Hemolytic Anemia (AIHA)

Two criteria must be diagnose AIHA: serologic evidence of an autoantibody and clinical or laboratory evidence of hemolysis. Serologic evidence of an autoantibody is provided by positive autocontrol and direct antiglobulin test (DAT, direct Coombs´ test) results and subsequent identification of an autoantibody in the RBC eluate and possibly the serum. Serum reactivity with autologous RBCs generally indicates the presence of an autoantibody, but it does not exclude the presence of an autoantibody.

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Serum Levels That Differentiate Anemia of Chronic Disease from Iron-Deficiency Anemia

Iron deficiency anemia develops when body stores of iron drop too low to support normal red blood cell (RBC) production. Inadequate dietary iron, impaired iron absorption, bleeding, or loss of body iron in the urine may be the cause.

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