Guidelines for Complications of Cancer Treatment Vol VIII Part B

time may represent increasing anemia severity, even if thehemoglobin level has not decreased to very low levels.Assessment also needs to ascertain underlying condition suchas nutritional deficiencies, inflammation, infection, hemolysis,blood loss, and other diagnoses in the context of cancer for anoptimal intervention to be designed.Assessing CIA- the NCCN recommendation 2008The NCCN have laid out certain broad parameters which helpassess cancer related anemia and gives a broad framework foradopting strategies to treat the same.. the recommendationsare as follows-Initial review should include a complete blood countwith indices and peripheral blood smear.The following studies should be completed if clinicallyindicated: reticulocyte count, iron studies, B12 and folicacid estimation, stool guaiac, LDH, fractionated bilirubinand reticulocyte count, bone marrow examination, directCoombs’s test, creatinine and/or creatinine clearance.If immediate correction is necessary, transfusion shouldbe considered.If hemoglobin is 10-11gm/dL, consider erythropoietintherapy after counseling regarding risks and benefits ofErythrocyte stimulating agents in those who aresymptomatic or at riskm of developing symptomaticanemia.Grading of CIAStandard grading systems define severe anemia as ahemoglobin level lower than 8 g/dl (grade 3 or higher), andthis hemoglobin level is also a transfusion trigger. However,several published reports have used different criteria forbaseline assessment of hemoglobin values including hematocrit481