The anemia of inflammation/malignancy: mechanisms and management.
Anemia is a common complication in patients with inflammatory diseases of many kinds, including cancer. The mechanisms that have captured the most attention include cytokine-mediated changes in both the production of and the response to erythropoietin (Epo), as well as important alterations in iron metabolism. The last is brought about by the relatively recently recognized peptide hormone, hepcidin. The availability of recombinant human Epo and its derivatives (known by class as Erythropoietic Stimulating Agents, ESAs) has dramatically changed anemia management in patients with cancer but, in the process, has raised as many issues as have been answered. This chapter reviews the mechanisms resulting in anemia in inflammation, including cancer, and focuses on the controversies around management with the ESAs and the adjuvant use of iron in anemia management.
Adamson
John W
JW
Division of Hematology/Oncology, University of California, San Diego, CA 92161, USA. john.adamson2@va.gov
D000740:Anemia / Q000209:etiology*; D023181:Antimicrobial Cationic Peptides / Q000378:metabolism; D002460:Cell Line; D004920:Erythropoiesis / Q000187:drug effects; D004921:Erythropoietin / Q000096:biosynthesis / Q000502:physiology* / Q000627:therapeutic use; D064451:Hepcidins; D006801:Humans; D007249:Inflammation / Q000150:complications*; D053582:Interleukin-1alpha / Q000494:pharmacology; D015850:Interleukin-6 / Q000494:pharmacology; D007501:Iron / Q000378:metabolism*; D009369:Neoplasms / Q000097:blood / Q000150:complications*; D011994:Recombinant Proteins; D014409:Tumor Necrosis Factor-alpha / Q000494:pharmacology
D023181:Antimicrobial Cationic Peptides; C578702:HAMP protein, human; D064451:Hepcidins; D053582:Interleukin-1alpha; D015850:Interleukin-6; D011994:Recombinant Proteins; D014409:Tumor Necrosis Factor-alpha; D004921:Erythropoietin; D007501:Iron