Anemia - Resources

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• Cancer. For select patients, erythropoietin is used to treat the anemia associated with chemotherapy.
• Chronic kidney disease. Erythropoietin is an important anemia treatment for patients with chronic kidney disease, including those with end-stage renal disease who are on dialysis.
• HIV/AIDS. Erythropoietin helps treat the anemia caused by zidovudine (AZT) therapy.

Erythropoiesis-Stimulating Drugs and Cancer. Erythropoietin may be used to treat anemia caused by chemotherapy. Erythropoietin treatment does not help prolong survival, but can improve quality of life during cancer treatment by improving anemia.

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However, these drugs can shorten survival time and cause some tumors to grow faster. In general, the lowest effective dose should be used. Survival and tumor growth risks are more of a concern when attempting to raise the hemoglobin level to between 10 - 12 g/dL or greater. The American Society of Clinical Oncology and the American Society of Hematology recommend starting erythropoietin only if a patient’s hemoglobin level is less than 10 g/dL.)

Discuss with your doctor whether an erythropoiesis-stimulating drug is appropriate for you.

Erythropoiesis-Stimulating Drugs and Chronic Kidney Disease. For patients with chronic kidney disease or kidney failure, the FDA currently recommends that erythropoiesis-stimulating drugs be used to maintain hemoglobin levels between 10 - 12 g/dL. (The exact level within this range varies by individual.) There is a greater risk of death and serious cardiovascular events, such as heart attack, stroke, and heart failure when these drugs are used to achieve higher hemoglobin levels (13.5 - 14g/dL) compared to lower hemoglobin levels (10- 11.3 g/dL).

Warning Symptoms. Contact your doctor if you have any of the following symptoms while being treated with an erythropoiesis-stimulating drug:

• Pain or swelling in the legs
• Worsening in shortness of breath
• Increases in blood pressure (be sure to regularly monitor your blood pressure)
• Dizziness or loss of consciousness
• Extreme fatigue
• Blood clots in hemodialysis vascular access ports

Vitamin Replacement for Megaloblastic Anemia

Megalobastic anemia is marked by abnormally large red blood cells. (Pernicious anemia is a type of megaloblastic anemia). It is caused by impaired absorption or insufficient intake of vitamin B12 and folate. Treatment usually involves taking a daily oral folic acid supplement for several months, as well as increasing intake of foods rich in folate and vitamin B12. Vitamin B12 tablets or nasal spray may also be recommended. Some patients may need monthly injections of vitamin B12, which is given either as cyanocobalamin or hydroxocobalamin.

Review Date: 01/13/2011
Reviewed By: Harvey Simon, MD, Editor-in-Chief, Associate Professor of Medicine, Harvard Medical School; Physician, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission (www.urac.org).