Correction of Epoetin-Resistant Megaloblastic Anaemia following Vitamin B&lt;sub&gt;12&lt;/sub&gt; and Folate Administration

Breen, Cormac; Macdougall, Iain C.

doi:10.1159/000045437

Cited by 7 publications

(5 citation statements)

References 8 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…There was a fall in MCV back to the normal range, and a rise in haemoglobin allowing reduction of rHu-EPO to reach target concentrations. These observations are in line with the anecdotal observation that correction of vitamin B12 and folate deficiency improved the responsiveness to erythropoietin in a patient who developed macrocytic anaemia during rHu-EPO therapy [16]. Furthermore, Pronai et al reported that folic acid supplementation improved erythropoietin response and normalized mean corpuscular erythrocyte volume in 11 patients with chronic renal failure receiving either conservative treatment or maintenance dialysis [17].…”

Section: Discussionsupporting

confidence: 62%

Folic acid deficiency modifies the haematopoietic response to recombinant human erythropoietin in maintenance dialysis patients

Schiffl¹,

Lang²

2005

Nephrology Dialysis Transplantation

View full text Add to dashboard Cite

Background. While folic acid deficiency causes macrocytic anaemia in non-renal patients, the relevance of altered folate metabolism in anaemia of end-stage renal disease and its response to rHu-EPO is less clear. Methods. Ten haemodialysis patients with macrocytic anaemia due to dietary folic acid deficiency were compared to 10 matched (age, duration of dialysis, degree of anaemia) patients with normocytic normochromic anaemia. Ninteen patients received erythropoietin-alpha intravenously thrice weekly. The study design was a prospective crossover (ABA) comparison of the effects of intravenously administered high doses of folic acid on haemoglobin levels and EPO doses, with 6 months active supplementation (B) and two periods of 6 months duration each without folic acid supplementation (A). Results. The two patient groups did not differ at recruitment. Red blood cell folate levels were normal in patients with normocytic anaemia, but they were subnormal in all patients with macrocytic anaemia. Compared to the first period without folic acid supplementation, patients with macrocytic anaemia had significantly higher haemoglobin levels despite lower EPO doses after 6 months high-dose folic acid, and red cells had become normocytic. The removal of folic acid supplementation resulted in re-occurrence of macrocytosis and in a significantly lower response to rHu-EPO. In contrast, high-dose folic acid supplementation had no effect on response to rHu-EPO in patients with normocytic anaemia. Conclusions. Folic acid deficiency may occur in elderly haemodialysis patients with poor dietary folate intake without regular oral supplementation and may cause hyporesponsiveness to rHu-EPO. Macrocytosis is a simple and cheap indicator for folate deficiency in end-stage renal disease patients on maintenance dialysis.

show abstract

Section: Discussionsupporting

confidence: 62%

Folic acid deficiency modifies the haematopoietic response to recombinant human erythropoietin in maintenance dialysis patients

Schiffl¹,

Lang²

2005

Nephrology Dialysis Transplantation

View full text Add to dashboard Cite

show abstract

“…Once baseline deficiency is excluded, we do not recommend further testing after commencing ESA therapy. Unlike iron deficiency, ESA hyporesponsiveness due to vitamin deficiency (folate or B 12 ) has only been cited in one case report to our knowledge. If vitamin B 12 deficiency is present at baseline, we prefer the use of oral vitamin B 12 2,000 mcg by mouth once daily for 3 months .…”

Section: Nutritional Deficiencies (Folate Vitamin B12 and Iron)mentioning

confidence: 99%

Diagnosis and treatment of cancer‐related anemia

2014

View full text Add to dashboard Cite

Cancer-related anemia (CRA) is due to multiple etiologies, including chemotherapy-induced myelosuppression, blood loss, functional iron deficiency, erythropoietin deficiency due to renal disease, marrow involvement with tumor as well as other factors. The most common treatment options for CRA include iron therapy, erythropoietic-stimulating agents (ESAs), and red cell transfusion. Safety concerns as well as restrictions and reimbursement issues surrounding ESA therapy for CRA have resulted in suboptimal treatment. Similarly, many clinicians are not familiar or comfortable using intravenous iron products to treat functional iron deficiency associated with CRA. This article summarizes our approach to treating CRA and discusses commonly encountered clinical scenarios for which current clinical guidelines do not apply.

show abstract

“…Nutritional deficiency should be corrected before consideration of ESA as per NCCN and ESMO recommendations. A case report by Breen et al found that patients' response to ESA is reduced in the presence of vitamin B12 deficiency or folate deficiency [17]. Patients with serum vitamin B12 concentration ≤210 pg/ml require vitamin B12 treatment (with an oral dose of 2,000 mcg/day for 3 months) followed by measurement of vitamin B12 value.…”

Section: Managementmentioning

confidence: 99%

Pathophysiology & Management of Anemia in Cancer Patients: A Systematic Review Nanda

Misra

2019

CTOIJ

View full text Add to dashboard Cite

Anemia is a common challenge among oncologists. Anemia has been directly implicated in the prognosis of cancer patients. Furthermore, correction of anemia-related symptoms can significantly improve the quality of life in these patients. We performed a systematic review of literature to improve our present knowledge on anemia in cancer patients. The data for review were identified by searching PubMed and Google Scholar and based on the recommendations from professional compendiums such as those by the National Comprehensive Cancer Network and European Society of Medical Oncology. The level of Hemoglobin is an established prognostic factor in many cancer patients. One of the reasons for this is that anemia will result in hypoxia and, subsequently, in tumor resistance to chemotherapy and radiotherapy. This review suggests that the ESAs (Erythropoietin Stimulating Agents) and intravenous iron should be used to maintain target hemoglobin level of 10 g/dl while the patient is receiving chemotherapy. However, long-term effect of intravenous iron treatment, ESAs use, and red blood cell transfusions should be further investigated.

show abstract

Correction of Epoetin-Resistant Megaloblastic Anaemia following Vitamin B<sub>12</sub> and Folate Administration

Cited by 7 publications

References 8 publications

Folic acid deficiency modifies the haematopoietic response to recombinant human erythropoietin in maintenance dialysis patients

Folic acid deficiency modifies the haematopoietic response to recombinant human erythropoietin in maintenance dialysis patients

Diagnosis and treatment of cancer‐related anemia

Pathophysiology & Management of Anemia in Cancer Patients: A Systematic Review Nanda

Contact Info

Product

Resources

About