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A Simple Anemia Overview
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Anemia
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Anemia is defined as "a pathologic deficiency in the oxygen-carrying material of the blood's hemoglobin." It is a common problem for cancer patients and is often a result of the therapies used to keep tumors at bay.
Anemia is associated with fatigue - a feeling of weakness or diminished physical and mental capacity unrelieved by rest. Additional symptoms include headache, dizziness, chest pain, and shortness of breath, nausea, depression and occasionally pain.
Causes of Anemia
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- Blood loss: excessive bleeding such as hemorrhages or abnormal menstrual bleeding
- Chronic Illness: inflammatory diseases, arthritis, kidney or liver failure, chronic infections
- Cancer therapy: Surgery, radiotherapy, chemotherapy, and/or immunotherapy
- Infiltration (replacement) of bone marrow with cancer
- Breakdown or destruction of red blood cells
- Decreased red cell production due to low levels of erythropoietin (a hormone produced by the liver and kidney which promotes red blood cell proliferation-- see discussion below).
Treatment of Anemias
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The successful treatment of anemias depends on identifying and treating the underlying cause: blood loss, bone marrow infiltration, chronic illness, inflammation, or decreased response to erythropoietin. Through laboratory test results and a physical examination, a physician can determine the cause of your anemia and identify the best approach to treating it. This may include:
- Nutritional supplements - Iron, B-12 or folic acid
- Treatment of infections and inflammations
- Blood Transfusions
Providing red blood cell transfusions for bleeding and severe chronic anemias. Red Cell Transfusions are the old mainstay which offers the quickest relief for anemias. However, there are risks associated with transfusions
- Allergic reactions
- Transmissions of infectious agents (hepatitis, HIV, and Human Leukemia Virus (HTLV)
- HBV (hepatitis B virus): 1 in 63,000
- HIV (AIDS) risk: 1 in 675,000 ( 5,000-1,000,000)
- HIV 2 : < 1 in 10,000,000
- HTLV (Human Leukemia virus): 1 in 641,000
- The Viral Risks of blood transfusions have recently been reduced due to a more accurate blood test called NAT (Nucleic Acid Test). This tests specifically for evidence of HIV and hepatitis C virus (HCV).
- Immune suppression
- Iron overload from multiple transfusions (usually over 25-50 units of red cells)
Administration of Erythropoietin injections
Erythropoitin (Epoetin alfa)
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Erythropoietin is a hormone produced by the kidneys (90%) and liver (10%) in response to anemia or low blood oxygen levels. Erythropoietin selectivity stimulates early red blood cell (erythroid) in the bone marrow to increase bone marrow activity. This, in turn, will help deliver more oxygen to the tissues and resolve some of the symptoms of weakness and fatigue.
A weakened bone marrow due to cancer infiltration (marrow replacement), lymphoma or leukemia may lead to low erythropoetin levels. These patients may respond to epoitin alfa (the commercial equivalent to erythropoetin) therapy. Patients who cannot produce adequate erythropoietin due to liver or kidney disease may also be helped by epoetin alfa injections.
Erythropoietin is generally well tolaerated. Some of the partial side effects include: hypertension, iron deficiency, occasionally minor allergies, edema, occasional increase diarrhea. It can cause growth of some tumors, especially myeloid leukemia.
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