Anemia

1. Anemia

2. Objective The learner will be able to define anemia and identify its cancer-related causes.

3. Red Blood Cells • Main purpose of red blood cells (RBCs) is to carry oxygen to the tissues. • Hemoglobin is an iron molecule surrounded by proteins (alpha and beta) that carries oxygen. • Cells lose their nucleus before entering the circulation from the bone marrow. • Cells become pliable and can travel through the microcirculation without damage.

4. Red Blood Cells • RBCs live approximately 120 days. • RBC production is stimulated by tissue hypoxia, especially in the kidney. • Kidney secretes erythropoietin, which stimulates RBC production. • Several nutrients are required to make RBCs: • Protein • Iron • Vitamin B12, folate

5. Anemia • Anemia  Reduced circulating RBCs that reduces circulating oxygen levels • Definition  A hemoglobin (Hgb) level of less than 12 g/dl (grams per deciliter) • Severity of symptoms  Determined by the rate at which anemia occurs, cause, and comorbidities • Most anemia happens slowly, but symptoms worsen as the Hgb level drops. • Rapid blood loss (hemorrhage) can result in acute symptoms in a very short period of time.

6. Defining Anemia by Grade/Severity

7. Causes of Anemia • Destruction/loss • Autoimmune hemolytic anemia – Antibody, transfusion • Hemolysis – Breakdown of cells (trauma, DIC, infection) • Bleeding – Blood loss (rapid or slow) (GI tract) • Inherited disorders – Sickle cell anemia, thalassemia • Production • Lack of nutrients – Iron, vitamins, proteins • Kidney failure – Lack of erythropoietin production • Chemicals – Drugs, chemotherapy, radiation • Cancer – Infiltration into the bone marrow • Chronic disease, organ dysfunction, aging

8. Signs and Symptoms of Anemia • Fast heartbeat (tachycardia) • Shortness of breath (SOB) when doing things like walking, climbing stairs, or even talking • Dizziness, light-headedness • Chest pain, angina • Swelling in the hands or feet • Pale skin, nail beds, mouth, and gums • Extreme tiredness (fatigue)

9. Diagnostic Testing for Anemia • Reticulocyte count – Immature RBCs • High: Normal or increased RBC production indicating blood loss or hemolysis • Low: Decreased RBC production indicating iron deficiency, B12/folate deficiency, aplastic anemia, kidney disease, or bone marrow dysfunction due to cancer or cancer treatment • Mean corpuscular volume (MCV) • If low, RBCs are small; can indicate iron deficiency. • If high, RBCs are large; can indicate B12/folate deficiency. • Hemoglobin electrophoresis – If hereditary abnormalities are suspected

10. Evidence-Based Interventions: Treatment Dependent on Cause • Blood loss • Iron (oral, intramuscular injection, intravenous) • Locate source and intervene (GI tract ulcer, heavy menstrual bleeding, etc.). • Destruction (hemolysis) • Autoimmune – Steroids; treat underlying cause. • Infection – Treat with appropriate antibiotics. • Cancer – Treat underlying malignancy.

11. Evidence-Based Interventions: Treatment Dependent on Cause • RBC production problems • Chronic renal disease – Erythropoiesis-stimulating agents (ESAs) (epoetinalfa, darbepoetinalfa) • Bone marrow dysfunction – Treat cancer, bone marrow transplant for aplastic anemia, ESAs • Hereditary anemias – Treat cause, transfuse • Bone marrow suppression: • Cancer treatments – Transfusion, ESAs (may cause early recurrence of cancer) • Lack of nutrients – Give iron, B12/folate, protein. • Improve organ dysfunction – Liver, kidneys, cardiovascular perfusion, lungs (improve oxygenation)

12. References National Comprehensive Cancer Network. (2012). NCCN Clinical Practice Guidelines in Oncology: Cancer- and chemotherapy-induced anemia [v.2.2012]. Retrieved from http://www.nccn.org/professionals/physician_gls/pdf/anemia.pdf Polovich, M., Whitford, J.M., & Olsen, M. (Eds.). (2009). Chemotherapy and biotherapy guidelines and recommendations for practice (3rd ed.).Pittsburgh, PA: Oncology Nursing Society.