Онкогематология (Oct 2020)
Pathogenetic and substitution correction of anemia in patients with malignant neoplasms
Abstract
Anemia in patients with malignant neoplasms affects the quality of life of the patient and sometimes limits the timely implementation of antitumor treatment. In the pathogenesis of anemia of the malignant neoplasms the largest role play infiltration of the bone marrow by tumor cells, suppression of hematopoiesis by inflammation cytokines, development of functional iron deficiency, reduction of sensitivity of receptors to erythropoietin or its synthesis. The doctor can prescribe effective pathogenetic therapy after evaluating the mechanisms of anemia development in this category of patients. In the article are described in detail the methods of pathogenetic correction of anemic syndrome using parenteral iron preparations, recombinant erythropoietin, indications for their appointment, effectiveness in patients with cancer, as well as possible side effects and complications of therapy. The mechanisms of action, pharmacokinetics, and features of the use of different erythropoietin adents are described. It is shown the effectiveness of erythropoietin preparations in patients with lymphoproliferative disorders based on the results of our own study. A positive response was observed in 77.3 % of patients with non-Hodgkin’s lymphomas, in 61.8 % – with multiple myeloma and 60.9 % with chronic lymphocytic leukemia. It is presented the prognostic factors for the response to erythropoietin therapy and showed own datum in patients with myelodysplastic syndrome (in case of the serum erythropoietin <500 mMU / ml a positive response was found in 35.6 %, with higher level – no response) and with lymphoproliferative disorders (in case of erythropoietin was <130 mMU / ml, the positive response was 80 %, at 130–499 mMU / ml – 63.6 %, and at ≥500 mMU / ml – 25 %). In the article are described the principles of anemia correction using red blood cells transfusions and features of their use in patients with cancer. Special attention is paid to the study of blood saturation as one of the indicators that allow us to assess the adequacy of the gas transport function of blood during red blood cells transfusions. The algorithm for correcting anemia in malignant neoplasms using red blood cells transfusions and erythropoietin agents are presented. It is shown low blood saturation (<60 %) in 32 % hematological malignancie’s patients with a hemoglobin 8.0 g / dL. This datum suggests presence of tissue hypoxia and gives approval to expand the threshold for red blood cells transfusions
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