Anaemia is a general term referring to a shortage of red blood cells or a reduction in their haemoglobin content. Haemoglobin is the pigment in the blood that carries oxygen in the red blood cells. A shortage of these red blood cells means that the blood is unable to carry adequate amounts of oxygen to all parts of the body. The subsequent reduction in oxygen in the tissues can cause severe damage.

Anaemia in cancer
Anaemia has been reported to affect over 50 percent of cancer patients. Numerous factors are involved, the most significant of which are shortened red blood cell life span, blood loss and suppression of production of red blood cells.

In addition to fatigue, many of the other consequences of cancer-related anaemia, namely cardiovascular, gastrointestinal and vascular symptoms, can adversely affect the quality of life of patients and possibly alter their response to cancer treatment. Studies have shown that the symptoms of cancer-related anaemia are exacerbated by commonly used cancer treatments, particularly platinum-based chemotherapy.

Management of anaemia in cancer
Anaemia in cancer used to be left largely untreated and was regarded by many physicians as a minor aspect of the disease and associated therapy. Nowadays, however, recognition of the severity of the negative impact of anaemia on quality of life, through fatigue, depression, nausea and the inability of patients to work or fulfil their social roles, has led to anaemia management becoming an integral part of quality treatment for cancer patients.

Previously, blood transfusions were the mainstay of treatment for cancer-related anaemia. However, approximately 20 percent of blood transfusions are associated with adverse reactions, some of which may be severe and/or life threatening. Nowadays recombinant human erythropoietin (rh-EPO) is used to treat anaemia. Erythropoietin acts by stimulating the production of red blood cells and prolonging their survival.

Anaemia in chronic kidney disease (renal anaemia)
Anaemia is extremely common in chronic kidney disease (CKD), affecting up to 90 percent of patients. Renal anaemia is found not only in patients with end stage renal disease (ESRD) receiving dialysis treatment, but also in patients who are not yet on dialysis. One of the most obvious consequences of renal anaemia is impaired function of the heart and blood vessels (cardiovascular dysfunction).

Management of renal anaemia
The extent of the devastating consequences of renal anaemia was not fully revealed until the development of recombinant human erythropoietin (rh-EPO). Following treatment with rh-EPO, patients showed improvements in many areas, including physical performance, contractility of skeletal muscle and overall well being. Nowadays, rh-EPO together with iron therapy is a standard treatment for hemodialysis patients with renal anaemia. However, treating renal anaemia in patients not yet receiving dialysis is extremely important in order to avoid cardiovascular dysfunction in the long term.