Table of contents

Cancer-related anemia


Key sources

The following summarized guidelines for the evaluation and management of cancer-related anemia are prepared by our editorial team based on guidelines from the American Society of Hematology (ASH/ASCO 2019) and the European Society of Medical Oncology (ESMO 2018). ...
Show more

Diagnostic investigations

Initial assessment
As per ASCO/ASH 2019 guidelines:
Elicit appropriate history, perform physical examination, and obtain diagnostic tests to identify alternative causes of anemia aside from chemotherapy or an underlying hematopoietic malignancy, and appropriately address such causes before offering ESAs.
Consider obtaining the following tests for baseline evaluation for anemia in patients with cancer receiving chemotherapy:
thorough drug exposure history
peripheral blood smear, and bone marrow examination in some cases
TIBC, transferrin saturation, ferritin, folate, vitamin B12, hemoglobinopathy screening, where indicated
reticulocyte count, occult blood loss, and assessment for renal insufficiency
baseline EPO level
serum TSH, where indicated
direct Coombs test in patients with chronic lymphocytic leukemia, non-Hodgkin's lymphoma, or history of autoimmune disease
Create free account

Medical management

Goals of treatment: as per ASCO/ASH 2019 guidelines, consider increasing hemoglobin level to the lowest concentration required to avoid or reduce the need for RBC transfusions, varying by patient and condition, in adult patients with chemotherapy-associated anemia being candidates for ESAs.

More topics in this section

  • ESAs (indications)

  • ESAs (choice of agent and dosing)

  • ESAs (discontinuation)

  • Iron replacement

Therapeutic procedures

RBC transfusion
As per ASCO/ASH 2019 guidelines:
Consider performing RBC transfusion in patients with chemotherapy-associated anemia depending on the severity of the anemia or clinical circumstances.
Consider performing blood cell transfusion in patients with non-myeloid hematologic malignancies receiving concurrent myelosuppressive chemotherapy.

Specific circumstances

Patients with refractory disease: as per ASCO/ASH 2019 guidelines, reevaluate patients not responding to ESAs for underlying tumor progression, iron deficiency, or other etiologies of anemia.