Guidelines for Complications of Cancer Treatment Vol VIII Part B

most accurate method for detecting functional iron deficiencyin these patients is the measurement of the percentage ofhypochromic RBCs or reticulocyte hemoglobin content. Suchmeasurements, however, require specialized instrumentationthat is not widely available. Consequently, the best methodfor evaluating available iron stores at the present time is thetransferrin saturation (TSAT). A TSAT of 20% to 30%generally indicates sufficient iron stores to supporterythropoiesis in rHuEPO- treated patients. (14) Thus,functional iron deficiency can be identified when serum ferritinis normal (100-300 ng/ml), transferrin saturation is at least orless than 20%, and when there are more than 10% ofhypochromic cells on PS.Management of anemia in cancerAssessing risk factorsIt is important to identify the risk group who are most likely tobe affected and prone to develop anemia. These includePatients receiving myelosuppressive chemotherapy or alarge area of radiation therapyA low hemoglobin level (10-12 g/dl) at the initiation ofcytotoxic therapy.Administration of platinum-containing regimensAssessing anemia in cancerThere is no standard. However, it is important to treat theindividual and set aside gender specific differences in normalhemoglobin levels. The trigger point will and has to vary foran intervention, be it using blood transfusion or growth factorsupport. The assessment should include the evaluation ofcurrent blood counts, pertinent laboratory values at baselineand assessment of physical symptoms (eg, pulmonary, cardiac,fatigue). Any change in trends related to these findings over480