Anemia

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Guidelines

NCCN

• 2012: Rodgers et al. Cancer- and chemotherapy-induced anemia. PubMed
• 2008: Rodgers et al. Cancer- and chemotherapy-induced anemia. PubMed
• 2003: Sabbatini et al. Anemia clinical practice guidelines in oncology. PubMed

Initial evaluation

May consist of:

• CBC with differential, MCV
• Basic metabolic panel (BMP)
• Liver function tests (LFTs)
• Reticulocyte count
• Iron, total iron binding capacity (TIBC), ferritin
• Vitamin B12 +/- methylmalonic acid & homocysteine
• Folic acid
• TSH
• Peripheral smear
• Clinical history, lifestyle factors (e.g. alcohol)
• Medications

GI bleeding or iron deficiency

• Stool occult blood
• EGD & colonoscopy
• Celiac (TTG IgA)
• H. pylori Ab, H. pylori stool antigen

Hemolysis?

• LDH
• Haptoglobin
• Direct & indirect Coombs
• LFTs (direct, indirect, total bilirubin)
• Infectious: anaplasma, babesia, ehrlichia

Anemia of chronic disease/anemia chronic kidney disease

• Basic metabolic panel (BMP) & iron labs as above
• Serum erythropoietin
• ESR
• CRP

Chronic/inherited?

• Hemoglobin electrophoresis
• Sickle cell evaluation

Myeloma?

• SPEP & IFE
• UPEP
• Free serum/urine kappa/lambda light chains
• Skeletal survey

Primary marrow process/hematologic malignancy

• Bone marrow biopsy

Less common

• Copper
• Zinc