Thalasemic pt with H&N ca

[Soossak]

Hello ,,


I want to ask about a case we r treating,, she is 50 years old female pt , with thalasemia and hb level of about 8-9max all through her life,, we are treating her for laryngeal ca, i'm confused about her blood level , given her 2 units of blood her blood rises to 9, i'm still not comfortable with her blood level ,, is there anything in literature for patients with chronic anemia ,,, dose it make a difference if she is chronic anemic , or all patients should have a hb level more than 10 for H&N ca????



How would u treat such patient????

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[Gfunk6]

Why would you treat her any differently from the standard?

 

[medgator]

Why would you treat her any differently from the standard?

I think the OP might be hinting at trying to use an EPO (erythropoeitin agent/stimulator) to bring her Hgb up to 10?? I think this is more a med onc question, but I do know that there is data to show that those agents can promote cancer growth in some situations.

 

[Gfunk6]

This is a known issue in cervical cancer, but I'm not aware of comparable H&N data.

 

[medgator]

This is a known issue in cervical cancer, but I'm not aware of comparable H&N data.

http://www.ncbi.nlm.nih.gov/pubmed/14575968

http://www.sciencedirect.com/science/article/pii/S1476558605800600

Seems like the OP should not use the H&N indication to determine whether the H/H should be corrected

 

[Soossak]

Why would you treat her any differently from the standard?

I thought maybe because she is chronic anemic that a hb of 8 would correlate for a hb of 10 for normal patient , that her body is adapted for such a low hb level, esp that her blood level does not rises with pRBC and that erythropiotin is not suitable ,,,

 

[Palex80]

Low hemoglobin levels are associated with worse outcome in the literature, but we do not know if this is a direct correlation between Hb and worse outcome or low Hb is simply an indicator of poor performace status, which may lead to lower survival itself.

However, I would probably transfuse her to levels around 10 before starting treatment.

 

[cdf95cro]

Anemia is prognostic, but don't transfuse or give EPO.


Transfusion is bad...


http://www.ncbi.nlm.nih.gov/pubmed/21790306

and EPO probably worse:

http://www.ncbi.nlm.nih.gov/pubmed/19588382

 

[Palex80]

Well in the DAHANCA trial they transfused patient with "low" levels of hemoglobin, when they had levels below 14.5 for males and 13 for females. That's quite a way off from the current 8 the OP has mentioned.
There is a theory that high hemoglobin levels can cause microcirculation problems by making the blood "too thick" and thus increase hypoxia, but I would be rather more comfortable with a patient having a hemoglobin level of 10 when entering intensive treatment.
Now the OP hasn't mentioned if its only going to be a small larynx field for a T1-T2 laryngeal tumor or some bigger volume for supraglottic or advanced disease. If it's the later you can expect Hb levels to drop even more during treatment...