PurvishM.ParikhCancer相关性贫血(CAA)仍然是一个主要的未满足的需求,它损害了总体生存率(OS)和生活质量(QoL)。目前,现有的指南没有考虑到低收入和中等收入国家(LMIC)的独特挑战。我们的CAA患者必须与先前存在的营养状况受损作斗争,身体铁库耗尽,财务限制,以及难以轻松获得负担得起的医疗保健。因此,我们满足了LMIC指南的需要。一组主题专家被放在一起,给定背景文献,在面对面的讨论中相遇,使用Delphi进程投票,并最终就该指南文件的内容达成一致。多达50%的癌症患者在初始诊断时将具有显著贫血(血红蛋白<10g/dL)。它最常见于胃肠道恶性肿瘤,头颈癌,和急性白血病.癌症定向治疗开始后血红蛋白进一步下降,由于化疗本身或营养缺乏加剧。其评估应包括全血细胞计数测试,红细胞形态学,网织红细胞计数,库姆斯试验,以及维生素B12和叶酸的水平。铁状态应使用测试来测量血清铁,总铁结合能力,转移饱和度,和血清铁蛋白水平.至少有50%的贫血癌症患者需要铁补充剂。优选的治疗模式是使用羧基麦芽糖铁(FCM)静脉内(IV)铁。大多数患者对1000mg的单剂量反应令人满意。它也是安全的,不需要使用测试剂量。在印度至少一半的癌症患者中发现了严重的贫血,南亚区域合作联盟区域,其他LMIC国家。它在医疗保健专业人员中的认识将防止它保持未被诊断(在所有癌症患者中多达70%)并对OS和QoL产生不利影响。用IV铁疗法治疗它们的好处是快速补充铁储备,血红蛋白恢复正常,更好的QoL,并避免输血感染/反应的风险。许多出版物已经证明了单剂量FCM在这种临床情况下的价值。CAA已被证明是一个独立的预后因素,对癌症患者的QoL和OS都有不利影响。在大多数CAA患者中,使用FCM作为1000mg的单次IV剂量是安全有效的。
Purvish M. ParikhCancer-associated anemia (CAA) remains a major unmet need that compromises overall survival (OS) and quality of life (QoL). Currently, available
guidelines do not take into consideration the unique challenges in low- and middle-income countries (LMIC). Our CAA patients have to battle preexisting impaired nutritional status, depleted body iron stores, financial limitations, and difficulty in having easily accessible affordable healthcare. Hence, we fulfilled the need of
guidelines for LMIC. A group of subject experts were put together, given background literature, met in a face-to-face discussion, voted using Delphi process, and finally agreed on the contents of this
guideline document. As many as 50% of cancer patients will have significant anemia (hemoglobin < 10 g/dL) at initial diagnosis. It is most commonly seen with gastrointestinal malignancies, head and neck cancers, and acute leukemias. The hemoglobin falls further after initiation of cancer directed therapy, due to chemotherapy itself or heightened nutritional deficiency. Its evaluation should include tests for complete blood count, red blood cell morphology, reticulocyte count, Coombs test, and levels of vitamin B12 and folic acid. Iron status should be monitored using test to measure serum iron, total iron binding capacity, transferring saturation, and serum ferritin levels. A minimum of 50% of cancer patients with anemia require iron supplements. The preferred mode of therapy is with intravenous (IV) iron using ferric carboxymaltose (FCM). Most patients respond satisfactorily to single dose of 1000 mg. It is also safe and does not require use of a test dose. Significant anemia is found in at least half of all cancer patients in India, South Asian Association for Regional Cooperation region, and other LMIC countries. Its awareness among healthcare professionals will prevent it from remaining undiagnosed (in up to 70% of all cancer patients) and adversely affecting OS and QoL. The benefits of treating them with IV iron therapy are quick replenishment of iron stores, hemoglobin returning to normal, better QoL, and avoiding risk of infections/reactions with blood transfusions. Many publications have proven the value of single-dose FCM in such clinical situations. CAA has been proven to be an independent prognostic factor that adversely affects both QoL and OS in cancer patients. Use of FCM as single IV dose of 1000 mg is safe and effective in the majority of patients with CAA.