P1: SBT
0521779407-03 CUNY1086/Karliner 0 521 77940 7 June 7, 2007 19:6
124 Anemias Secondary to Systemic DiseaseB12 deficiency, plasma cell dyscrasia (serum protein electrophore-
sis), true thyroid abnormalities, myelodysplasia, serum creatine and
erythropoietin level. Sedimentation rate or C-reactive protein may
be helpful.
■Bone marrow generally useful only lto rule out other conditions
■Age-appropriate cancer screening always indicatedspecific therapy
■Correcting underlying condition is best treatment.
■Other treatment may not be necessary if hematocrit >30% and
patient is not symptomatic. However, studies have suggested that
quality of life is improved in cancer patients whose anemias are rig-
orously treated. Beware of risks of anemia in older patients or those
with cardiac disease.
■If treatment is needed, pharmacologic doses of erythropoietin
should be given: 5–10,000 U 3X week or 40,000 Units once a week
subcutaneously. Alternatively, longer-acting forms of erythropoietin
(aranesp) may be equally effective (100 units every 1–2 weeks to
start).
Because of poor iron utilization with systemic inflammation, iron
administration, intravenous or oral, may increase the response to
erythropoietin, even in the presence of high serum ferritin (NB: Both
are off-label indications.)
■Patients with low pretreatment erythropoietin levels and without
bone marrow or hematologic malignancies respond best. However,
there is no pretreatment erythropoietin level that should preclude a
pharmacologic trial of erythropoietin, if indicated.follow-up
■A response to erythropoietin should be seen in 4–6 weeks.
■Response rates: 40–80%
■If no response, erythropoietin may be increased to 60,000 Units q
week subcutaneously.
■Studies suggest that if after 2 weeks the serum epo is >100 mU/mI
and the hemoglobin has not increased by >0.5 gIdl, or after 2 weeks
of treatment the serum ferritin is >400 ng/ml, then patient is less
likely to respond.complications and prognosis
n/a