Anemia in cancer

Thursday, April 11, 2019

You can contact Blood & Cancer at podcasts@mdedge.com and you can follow MDedge Hematology Oncology on Twitter @MDedgeHemOnc.

Episode 11:

John A. Glaspy, MD, of the University of California, Los Angeles joins Blood & Cancer host, David Henry, MD, to discuss treatment of anemia in cancer patients, specifically chemotherapy-induced anemia.

In this week’s Clinical Correlation, Ilana Yurkiewicz, MD, poses the question, is there such a thing as well placed apathy when it comes to coping with cancer? Dr. Yurkiewicz has a column at MDedge, which you can find by clicking here.

Show notes

By Emily Bryer, DO, resident in the department of internal medicine, University of Pennsylvania

  • Hemoglobin is associated with quality of life and functional status, and quality of life improves continuously as hemoglobin rises from low (8 g/dL) to normal (12 g/dL) levels.
  • The complete workup of anemia involves reticulocyte count, iron studies, folate, B12, peripheral smear, and creatinine.
  • Anemia is a consequence of 1) cancer and 2) chemotherapy
    • In patients with malignancy, the inflammatory state results in iron-restricted erythropoiesis, so patients may be functionally iron deficient even if their iron stores are replete.
  • How do we treat anemia in cancer?
    • Blood transfusion to rapidly improve hemoglobin
    • Intravenous iron, if iron deficient
    • Erythrocyte stimulating agents (ESA), if iron stores are replete. (Although IV iron augments ESA response in all cancer studies reported so far.)
      • Risks associated with blood transfusion: Infection, transfusion-related-lung-injury, reactions to mismatched or well-matched blood, and iron overload (specifically in myelodysplastic syndrome).
    • Recent FDA-mandated studies in anemic metastatic breast and non-small-cell lung cancer patients have demonstrated that there is no difference in survival among patients who receive ESA or placebo to treat their cancer/chemotherapy-associated anemia.
    • HIF-1-alpha (hypoxia-inducible-factor) is a transcription factor produced in response to hypoxia.
      • New class of drugs stabilizing HIF can result in both an increase in erythropoiesis and a decrease in hepcidin.

References

  1. 2010 Dec 2;116(23):4754-61.
  2. Cancer Metastasis Rev.2007 Jun;26(2):341-52.
  3. Support Care Cancer.2006 Dec;14(12):1184-94.
  4. Cochrane Database Syst Rev.2016 Feb 4;2:CD009624.
  5. International Journal of Clinical Transfusion Medicine. 2018;6:21-31.

Podcast Participants

David Henry, MD
David Henry, MD, FACP, is a clinical professor of medicine at the University of Pennsylvania and vice chairman of the department of medicine at Pennsylvania Hospital in Philadelphia. He received his bachelor’s degree from Princeton University and his MD from the University of Pennsylvania, then completed his internship, residency, and fellowship at the Hospital of the University of Pennsylvania. After 2 years as an attending in the U.S. Air Force, he was drawn to practicing as a hem-onc because of the close patient contact and interaction, and his belief that, win or lose with each patient, one can always make a difference in their care and lives. Follow Dr. Henry on Twitter: @davidhenrymd.
Ilana Yurkiewicz, MD
Ilana Yurkiewicz, MD, is a fellow in hematology and oncology at Stanford University, where she also completed her internal medicine residency. Dr. Yurkiewicz holds an MD from Harvard Medical School and a BS from Yale University. She went into hematology and oncology because of the high-stakes decision-making, meaningful relationships with patients, and opportunity to help people through some of the toughest challenges of their lives. Dr. Yurkiewicz is also a medical journalist. She is a former AAAS Mass Media Fellow and Scientific American blog columnist, and her writing has appeared in numerous media outlets including Hematology News, where she writes the monthly column Hard Questions. Dr. Yurkiewicz is on Twitter: @ilanayurkiewicz.