Advertisement

Medical Oncology

, Volume 20, Issue 3, pp 301–306 | Cite as

Epoetin alfa and intravenous iron sucrose to treat severe anemia in a patient with chronic radiation enteropathy

A case report
  • Sophie Séronie-VivienEmail author
  • Loïc Mourey
  • Moustapha Tohfe
  • Roland Bugat
Case Report
  • 41 Downloads

Abstract

We report the case of a patient with a severe chronic radiation enteropathy. She had been dependent on red cell transfusions for many years. On admission, she displayed anemia (8.6 g/dL) resulting from both inadequate EPO production and a functional iron deficiency. A 3-wk IV iron sucrose treatment (200 mg once weekly) resulted in an increased reticulocyte count, but did not raise the hemoglobin (Hb) level. The adjunction of epoetin alpha (10,000 IU three times a week) made it possible to reach the normal range (12.9 g/dL) after a 17-wk treatment. As the anti-anemic treatment discontinued, the Hb level decreased to 11.1 g/dL within 2 wk. Giving EPO again (10,000 IU twice a week) failed to maintain the Hb level, which dropped under basal values (7.8 g/dL). In contrast, a second combination EPO/iron sucrose did restore a normal Hb level and maintained it. This case report supports the combination of EPO and IV iron supplementation in patients with anemia of chronic disease and either an impaired iron absorption or intolerance to oral iron.

Key Words

Anemia erythropoietin IV iron functional iron deficiency chronic radiation enteropathy 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Cosnes J, Gendre JP, Le Quintrec Y. Chronic radiation enteritis. II. General consequences and prognostic factors. Gastroenterol Clin Biol 1983; 7(8–9):671–676.PubMedGoogle Scholar
  2. 2.
    Cazzola M, et al. Subcutaneous erythropoietin for treatment of refractory anemia in hematologic disorders. Results of a phase I/II clinical trial. Blood 1992; 79(1):29–37.PubMedGoogle Scholar
  3. 3.
    Ludwig H, Fritz E, Kotzmann H, Hocker P, Gisslinger H, Barnas U. Erythropoietin treatment of anemia associated with multiple myeloma. N Engl J Med 1990; 322(24):1693–1699.PubMedCrossRefGoogle Scholar
  4. 4.
    Glaspy JA, et al. Darbepoetin alfa given every 1 or 2 weeks alleviates anaemia associated with cancer chemotherapy. Br J Cancer 2002; 87(3):268–276.PubMedCrossRefGoogle Scholar
  5. 5.
    Lavey RS, Dempsey WH. Erythropoietin increases hemoglobin in cancer patients during radiation therapy. Int J Radiat Oncol Biol Phys 1993; 27(5):1147–1152.PubMedGoogle Scholar
  6. 6.
    Littlewood TJ, Bajetta E, Nortier JW, Vercammen E, Rapoport B. Effects of epoetin alfa on hematologic parameters and quality of life in cancer patients receiving non-platinum chemotherapy: results of a randomized, double-blind, placebo-controlled trial. J Clin Oncol 2001; 20(11):2865–2874.Google Scholar
  7. 7.
    Osterborg A, et al. Randomized, double-blind, placebo-controlled trial of recombinant human erythropoietin, epoetin beta, in hematologic malignancies. J Clin Oncol 2002; 20(10):2486–2494.PubMedCrossRefGoogle Scholar
  8. 8.
    Daneryd P. Epoetin alpha for protection of metabolic and exercise capacity in cancer patients. Semin Oncol 2002; 29(3 Suppl 8):69–74.PubMedCrossRefGoogle Scholar
  9. 9.
    Beguin Y. Prediction of response to treatment with recombinant human erythropoietin in anaemia associated with cancer. Med Oncol 1998; 15(Suppl) 1:38–46.Google Scholar
  10. 10.
    Adamson JW, Ludwig H. Predicting the hematopoietic response to recombinant human erythropoietin (epoetin alfa) in the treatment of the anemia of cancer. Oncology 1999; 56(1):46–53.PubMedCrossRefGoogle Scholar
  11. 11.
    Miller CB, Jones RJ, Piantadosi S, Abeloff MD, Spivak JL. Decreased erythropoietin response in patients with the anemia of cancer. N Engl J Med 1990; 322(24):1689–1692.PubMedCrossRefGoogle Scholar
  12. 12.
    Thomas C, Thomas L. Biochemical markers and hematologic indices in the diagnosis of functional iron deficiency. Clin Chem 2002; 48(7):1066–1076.PubMedGoogle Scholar
  13. 13.
    Beguin Y. Erythropoietin and the anemia of cancer. Acta Clin Belg 1996; 51(1):36–52.PubMedGoogle Scholar
  14. 14.
    Glaspy J, Cavill I. Role of iron in optimizing responses of anemic cancer patients to erythropoietin. Oncology (Huntingt) 1999; 13(4):461–473.Google Scholar
  15. 15.
    Stenvinkel P. The role of inflammation in the anaemia of end-stage renal disease. Nephrol Dial Transplant 2001; 16(Suppl 7):36–40.PubMedGoogle Scholar
  16. 16.
    NKF-DOQI clinical practice guidelines for the treatment of anemia of chronic renal failure. National Kidney Foundation-Dialysis Outcomes Quality Initiative. Am J Kidney Dis 1997; 30(4 Suppl 3): S192–S240.Google Scholar
  17. 17.
    Breymann C, Richter C, Huttner C, Huch R, Huch A. Effectiveness of recombinant erythropoietin and iron sucrose vs. iron therapy only, in patients with postpartum anaemia and blunted erythropoiesis. Eur J Clin Invest 2000; 30(2):154–161.PubMedCrossRefGoogle Scholar
  18. 18.
    Gasche C, et al. Intravenous iron and erythropoietin for anemia associated with Crohn disease. A randomized, controlled trial. Ann Intern Med 1997; 126(10):782–787.PubMedGoogle Scholar
  19. 19.
    Rohling RG, Zimmermann AP, Breymann C. Intravenous versus oral iron supplementation for preoperative stimulation of hemoglobin synthesis using recombinant human erythropoietin. J Hematother Stem Cell Res 2000; 9(4):497–500.PubMedCrossRefGoogle Scholar
  20. 20.
    de Pree C, Mermillod B, Hoffmeyer P, Beris P. Recombinant human erythropoietin as adjuvant treatment for autologous blood donation in elective surgery with large blood needs (> or=5 units): a randomized study. Transfusion 1997; 37(7):708–714.PubMedCrossRefGoogle Scholar
  21. 21.
    Auerbach M, Barker L, Bahrain H, Trout M, Mcllwain M, Ballard H. Intravenous iron (IV Fe) optimizes the response to erythropoietin (EPO) in patients with anemia of cancer and cancer chemotherapy: results of a multicenter, open randomized trial. Proceeding of the 42nd Annual Meeting of The American Society of Hematology. Abstract # 3323, 12-10-2001.Google Scholar
  22. 22.
    Dicato M, Duhem C, Berchem G, Ries F. Clinical benefit from erythropoietin. Curr Opin Oncol 2000; 12(4):297–302.PubMedCrossRefGoogle Scholar
  23. 23.
    Ludwig H, Fritz E, Leitgeb C, Pecherstorfer M, Samonigg H, Schuster J. Prediction of response to erythropoietin treatment in chronic anemia of cancer. Blood 1994; 84(4):1056–1063.PubMedGoogle Scholar

Copyright information

© Humana Press Inc 2003

Authors and Affiliations

  • Sophie Séronie-Vivien
    • 1
    Email author
  • Loïc Mourey
    • 2
  • Moustapha Tohfe
    • 2
  • Roland Bugat
    • 2
  1. 1.Department of BiologyInstitut Claudius RegaudToulouse CedexFrance
  2. 2.Department of Clinical OncologyInstitut Claudius RegaudToulouse CedexFrance

Personalised recommendations