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.
Similar content being viewed by others
References
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.
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.
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.
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.
Lavey RS, Dempsey WH. Erythropoietin increases hemoglobin in cancer patients during radiation therapy. Int J Radiat Oncol Biol Phys 1993; 27(5):1147–1152.
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.
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.
Daneryd P. Epoetin alpha for protection of metabolic and exercise capacity in cancer patients. Semin Oncol 2002; 29(3 Suppl 8):69–74.
Beguin Y. Prediction of response to treatment with recombinant human erythropoietin in anaemia associated with cancer. Med Oncol 1998; 15(Suppl) 1:38–46.
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.
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.
Thomas C, Thomas L. Biochemical markers and hematologic indices in the diagnosis of functional iron deficiency. Clin Chem 2002; 48(7):1066–1076.
Beguin Y. Erythropoietin and the anemia of cancer. Acta Clin Belg 1996; 51(1):36–52.
Glaspy J, Cavill I. Role of iron in optimizing responses of anemic cancer patients to erythropoietin. Oncology (Huntingt) 1999; 13(4):461–473.
Stenvinkel P. The role of inflammation in the anaemia of end-stage renal disease. Nephrol Dial Transplant 2001; 16(Suppl 7):36–40.
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.
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.
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.
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.
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.
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.
Dicato M, Duhem C, Berchem G, Ries F. Clinical benefit from erythropoietin. Curr Opin Oncol 2000; 12(4):297–302.
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.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Séronie-Vivien, S., Mourey, L., Tohfe, M. et al. Epoetin alfa and intravenous iron sucrose to treat severe anemia in a patient with chronic radiation enteropathy. Med Oncol 20, 301–306 (2003). https://doi.org/10.1385/MO:20:3:301
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1385/MO:20:3:301