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Upon completion of the chapter, the reader will be able to:

  1. Identify common causes of anemia.

  2. Describe common signs and symptoms of anemia.

  3. Describe diagnostic evaluation required to determine the etiology of anemia.

  4. Recommend a treatment regimen for anemia considering the underlying cause and patient-specific variables.

  5. Compare and contrast commonly prescribed oral and parenteral iron preparations.

  6. Explain the optimal use of folic acid and vitamin B12 in patients with macrocytic anemia.

  7. Evaluate the proper use of epoetin and darbepoetin in anemia patients with cancer chemotherapy associated or chronic kidney disease.

  8. Develop a plan to monitor the outcomes of anemia pharmacotherapy.




  • Image not available. Anemia is a below-normal concentration of hemoglobin (Hgb) that results in a reduction of the oxygen-carrying capacity of the blood.

  • Image not available. Common signs and symptoms of anemia include fatigue, lethargy, dizziness, shortness of breath, headache, edema, and tachycardia.

  • Image not available. A complete blood count (CBC) is the laboratory evaluation that provides objective characteristics of red blood cells (RBCs) useful in determining etiology and appropriate treatment.

  • Image not available. The goal of anemia therapy is to increase Hgb concentrations to levels that improve RBC oxygen-carrying capacity, alleviate symptoms, and prevent anemia complications.

  • Image not available. The underlying cause of anemia (e.g., iron, folic acid, or B12 deficiency; blood loss; or chronic disease) must be determined and used to guide therapy.

  • Image not available. In patients with iron-deficiency anemia (IDA), appropriate oral iron therapy should be attempted before giving parenteral iron.

  • Image not available. Anemia from vitamin B12 or folic acid deficiency is effectively treated by administration of the deficient nutrient.

  • Image not available. In patients with anemia related to cancer chemotherapy or chronic kidney disease (CKD), administration of erythropoietin-stimulating agents (ESAs) can increase Hgb and decrease transfusion requirements.

  • Image not available. ESAs have significant safety risks that require careful monitoring. Use the lowest dose of epoetin alfa and darbepoetin alfa to avoid RBC transfusions.

  • Image not available. At appropriate intervals, patients should be monitored for Hgb response, symptom resolution, and adverse effects and treatment regimens adjusted accordingly.




Image not available. Anemia is a reduction in the concentration of hemoglobin (Hgb) that results in reduced oxygen-carrying capacity of the blood. Some patients with anemia may be asymptomatic initially, but eventually, the lack of oxygen to tissues results in fatigue, lethargy, shortness of breath, headache, edema, and tachycardia. Common causes of anemia include blood loss, decreased red blood cell (RBC) production, increased RBC destruction, or a combination of these events. Determination of the underlying cause of anemia is essential for successful management. Appropriate treatment of anemia will result in an increase in Hgb, with a corresponding increase in oxygen-carrying capacity and reduction in symptoms.




Anemia is a common diagnosis with a prevalence that varies widely based on age, gender, and race/ethnicity (see Table 66–1).1,2 Patients with specific comorbidities such as cancer and chronic kidney disease (CKD) have significantly higher rates of anemia. The incidence ...

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