Efficacy of Ferric Carboxymaltose in Anaemia of Malignancy - A Pilot Study.

Anaemia is an important problem in malignancy. It may be due to chronic causes like malnutrition, marrow infiltration, associated renal or endocrine disorders and it may be complicated with blood loss. Measures like blood transfusion, erythropoietin injections often pose a logistical problem. Parenteral iron injections have proved to be useful in fighting anaemia in some chronic conditions e.g. patients on hemodialysis. Aims and Objectives: Primarily to see the observable change in hemoglobin (Hb) level with ferric carboxymaltose (FCM) in treating patients of malignancy on anti-cancer treatment. Materials and Methods: Twenty seven patients were enrolled for this study who were suffering from various malignancies. The baseline Hb level was estimated and FCM injection was administered as per the schedule of 500 mg intravenously (IV) weekly once. The overall results of increase in Hb level was noted during the middle of the treatment (chemotherapy or radiotherapy) and later 3-4 weeks after treatment completion. The results were analysed using SPSS and the mean values of initial Hb and after treatment were analysed. Level of significance (p value) was noted using t test. Results: In 27 patients the mean initial Hb level was 8.09 g/dl before treatment which increased to 10.28 g/dl after FCM treatment (p <0.0001). Conclusion: Treatment with FCM definitely led to a significant increase in Hb level in patients of malignancy undergoing treatment. However, further detailed study is needed to establish its definite role in improving the body iron parameters.

Monitoring and optimizing the dose response relationship of erythropoietin in haemodialysis patients

Renal disease is characterized by failure of erythropoietin production and low bone marrow sensitivity to erythropoietin. Renal anemia is repidly corrected by recombinant human erythropoietin therapy but the dose required varies greatly [Lind et al., 1997]. In this study, the erythropoietin doses required for the treatment of anemia of renal failure were monitored and optimized by using the recent flow cytometric reticulocyte analysis and testing the parameters of bone marrow response to different erythropoietin doses. This work was carried out on forty patients, with recent onset of haemodialysis for end stage renal disease without any history of previous erythropoietin therapy. After exclusion of common causes that may cause resistance to erythropoietin [EPO] therapy like iron deficiency, blood loss, hyperparathyroidism and aluminum toxicity, the patients were divided into two groups: Group A and group B. Group A had 10 patients who received non-erythropoietin bone marrow stimulants in the from of anabolic steroids. And group B had 30 patients which were further subdivided into three subgroups I/II and III and received EPO therapy at a dose of 30, 40 and 50 I.U/Kg BW S.C. times/week respectively. All the patients were investigated by doing: s. PTH, s. iron indices/ s. Aluminum, blood indices, uper endoscopy, stool analysis for occult blood and flow cytometric determination of RMI. Administration of non-erythropoietin bone marrow stimulants in the form of anabolic steroids in group A showed insignificant increase in Hb%/ reticulocyte maturity index [RMI] and absolute reticulocyte count [ARC]. EPO therapy in the doses of 30/ 40 and 50 I.V/Kg body weight thrice/week S.C [group B I/ II and III respectively] showed a significant increase in Hb% on the 2nd and 3rd month from the begining of the study. So, administration of recombinant human EPO in pharmacological quantities enabled a more efficient therapy of ESRD-induced anemia and significantly reducing the need for blood transfusion

Study of some effects of recombinant human erythropoietin [r-HuEpo] administration on anemic hemodialysis [HD] patients

The cardinal effect of erythropoitin is the induction of division and differentiation of marrow stem cells into recognisable erythroblast precursors. Iron deficiency anaemia is common among HD patients due to frequent blood loss and or poor absorption if not counteracted by the removal of haem synthesis inhibitors. Recombinant erythropoitin [r-HuEpo] administration was tried in six HD patients for one year. The effect of treatment on clinical condition was perfect although non significant improvement of Hb, Ht, reticulocyte and platelet count was found. Also elevation of serum iron, transferrin saturation and ferritin was quite little. Should all HD patients with iron deficiency anaemia receive r-HuEpo. The decision will not only depend on the cost, but will be influenced by the effect of treatment on improvement of the clinical and laboratory findings