Anemia is one of the
most common conditions associated with cancer, with 50%
to 60% of cancer patients experiencing anemia at some time
during the course of their illness and treatment.
The blood in our body is composed of three types of cells (red blood cells, white
blood cells, and platelets) that circulates throughout the body. Red blood cells
contain hemoglobin(Hb), a red, Iron-rich protein that carries oxygen from the
lungs to all of the body muscles and organs. Oxygen provides the energy the body
needs for all of its normal activities. Anemia occurs when the number of red
blood cells (or the Hb in them) falls below normal and the body gets less oxygen
and therefore has less energy than it needs to function properly.
When the number of red blood cells decreases, the heart works harder, pumping
more blood to send more oxygen throughout the body. If heart works too hard,it
can develop a rapid heartbeat and / or another serious condition known as left
ventricular hypertrophy (LVH),an enlargement of the heart muscle, that in turn
can lead to heart failure.
Epidemiology
:-
Prevalence of anemia
due to cancer progression varies based on the definition
of anemia and the type of cancer involved. It ranges from
5% (prostate cancer) to as high as 90% (Multiple myeloma).
Prevalence of anemia appears to be high in patients with
Head & neck cancers, uterine-cervical cancers, advanced
multiple myeloma, lymphoma, lung, ovarian, other genitourinary
cancers and those suffering from cancer related renal impairment.
A broad review of clinical trial noted that mild anemia
after chemotherapy can occur in 100% patients and incidence
of more severe anemia can reach 80%. Radiation therapy
can also increase the incidence of anemia in cancer patients.
Causes
:-
Cancer related anemia
falls into three distinct categories-
Anemia as a result of the malignancy; Red blood cell
survival is frequently shortened and the production
is impaired, possibly because of the action of immune
and inflammatory cytokines (TNF, INTERFERON,INTERLEUKIN-1)
activated by the presence of tumor.
Which in turn
results in
Impaired iron
utilization
Suppression of precursor
cells of RBCs
Inadequate erythropoietin
production.
Anemia attributed to the form
of cancer therapy applied;
Many cancer chemotherapeutic
agents result in anemia as their toxic effects,for
eg Cisplatin, Etoposide, Cytarabine, Mercaptopurine,Topotecan,
Irinotecan, Doxorubicin etc. severe anemia may result
in 16-55% patients
Bleeding from tumor bed or bleeding due to systemic Coagulopathy may also contribute
to anemia in these Patients.
Anemia resulting from one or
more contributing factors :-
“It is common for people
to ignore Symptoms of anemia Or Attribute them to other
Causes………
Anemia can be difficult to identify
because early symptoms may be mild.
Major
symptoms & signs
of anemia include;
Extreme Fatigue
Weakness
Nausea, Anorexia
Shortness of breath
Confusion or loss of concentration
Dizziness or
fainting
Pale skin, including decreased
pinkness Of the lips, gums,lining of eyelids, Nailbeds
and palms
Palpitation (Thumping in
the heart)
Feeling cold
Apathy, sluggishness
Sadness or depression
Loss of libido
Particularly for a person with
a serious disease, The fatigue, weakness and other
symptoms associated with anemia can compound the challenges
of coping with the serious disease, and Fatigue being
the most common and important clinical manifestation
of anemia in cancer patients. Accurate assessment of
anemia and fatigue is important to ensure that patients
are optimally Managed. Assessment should incorporate
Laboratory Parameters, physical symptoms, and Quality
of Life (QOL) indicators. Brief assessment composed
of a few simple questions in the form of questionnaires
which evaluate the fatigue and QOL in patients of cancer
related anemia.
Patient-reported areas of daily
life negatively affected By fatigue:
Ability to work
Physical well being
Ability to enjoy life in
the moment
Emotional well being
Intimacy with partner
Ability to take
care of the family
Relationships with family
and friends
Concerns about mortality and survival
Diagnosis
:-
Anemia is diagnosed by;
Reduction in
Hb level, Normal range
(13.5g/dl-17.5g/dl in males) , (11.5g/dl-15.5g/dl in females)
Reduction in Number of RBCs
or
Erythrocytes, normal range (4.5 to 5.5 Million/mm3).
Reduction in Packed cell volume (hematocrit)
Normal range 30-36%
On the basis of Hb levels anemia
is classified as-
-
Mild- 10 g/dl
-11 g/dl
-
Moderate- 8 g/dl – 10
g/dl
-
Severe - < 8 g/dl
Management:-
The management of anemia
in patients with cancer should be based on the severity
of associated Symptoms and also to supplement the ongoing
anti cancer treatment. For e.g. radiotherapy requires oxygen
in the tissues. In anemic patients due to less O2 in the
tissue radiotherapy(RT) will be less effective. So those
patients who are going for radiotherapy, correction of
anemia and to maintain Hb level above 10.0 gm% is very
essential throughout treatment
Corrections of nutritional
deficiencies- like Iron, Folic acid, Vit-B12. As well as
correction of underlying cause of occult blood loss, or
infections.
Non Pharmacological Interventions like exercise for
the management of cancer related fatigue. restorative
therapy, sleep, hygiene, nutritional consultation and
education.
Non Pharmacological Interventions like exercise for
the management of cancer related fatigue. restorative
therapy, sleep, hygiene, nutritional consultation and
education.
Red blood cell transfusions
:-
Red blood cell transfusions
are a rapid and reliable method of correcting anemia, especially
in life threating situations.This rapidly raises the RBC
count and Hb concentration and is effective mode of treatment
virtually in all patients. But, in addition, transfusion
is associated with potential risks, including transmission
of infectious agents, (like hepatitis B, Hepatitis C, HIV
), which may further cause delay in cancer treatment, allergic,
febrile and hemolytic reactions, iron and circulatory overload.
And possibly an unfavorable effect on overall outcome of
cancer management.
Erythropoietin (growth factor for RBCs)
The introduction of
recombinant human erythropoietin (rHuEPO) has proven to
be a major advance in the
therapeutic options available for managing anemia in cancer patients. The use
of erythropoietic agents is
recommended in cancer patients with chemotherapy related anemia and a Hb level <10
g/dl. Erythropoietic
therapy should be strongly considered in patients with symptomatic anemia and
Hb level <10 g/dl, and considered in patients with Hb levels 10 – 11
g/dl.
The recommended starting dose of erythropoietin for adults is 150 Units/kg subcutaneously
(SC) thrice in week.
The hematocrit and Hb levels should be monitored on weekly basis in patients
receiving erythropoietin therapy until becoming stable.
Usually rise in 1g/dl of Hb level in one month, is considered As positive response.
Erythropoietin is available as prefilled syringes, may be given as an IV or SC
injection.
SC injections can also
be self-administered, as prescribed for the length of time
specified by your physician.
Erythropoietin is generally
well-tolerated and producing stable Hb levels, avoid the
fluctuation associated with RBC transfusions as well as
reduces RBC transfusion requirements in anemic cancer patients
receiving chemotherapy. The adverse events reported are
frequent sequelae of disease and are not necessarily attributable
to erythropoietin therapy.
The adverse event reported with use of erythropoietin are minimal increase in
blood pressure, headache, joint pain, nausea, edema, fatigue, diarrhea, vomiting,
chest pain, skin reaction at administration site, dizziness, Constipation, deep
vein thrombosis.
The demonstrated efficacy of epoietin (erythropoietin) alfa for increasing Hb
levels, reducing transfusion requirements and improving patient (QOL) have made
this agent a rationale choice for management of cancer related anemia.
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overview only. It is meant to improve your broad Understanding
only. This information may not apply to everyone. Consult
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