Anemia in malignant diseas – treatment algorithm

Anemija se u maligno oboljelih javlja s velikom učestalošću te joj se prevalencija kreće od 20 do 60 %. Uzroci nastanka anemije u maligno oboljelih mogu biti mnogostruki, kao što su već sama prisutnost zloćudne bolesti , terapija zloćudne bolesti te različita druga stanja (infekcije, nutriti vni defi cit, prisutnost druge kronične bolesti itd.). Prisutnost anemije kod maligno oboljelih negati vno utječe na sve fi ziološke sustave i njihove funkcije, a naročito na središnji živčani, kardiorespiratorni sustav te na bubrežnu funkciju, stoga se ovi bolesnici osjećaju znatno lošije nego što bi to uzrokovala sama osnovna bolest, a prisutnost, odnosno odsutnost anemije utječe na mogućnosti i izbor načina liječenja te je ujedno i jedan od prognosti čkih čimbenika preživljenja kod brojnih tumora. Iako je vrlo učestala, anemija se kod maligno oboljelih često previđa i podcjenjuje te samo oko 40 % bolesnika koji su anemični, a istodobno imaju zloćudnu bolest, prima terapiju u svrhu liječenja anemije. Za sprječavanje i liječenje anemije prije svega je potrebno liječiti osnovnu bolest. Danas je, prema smjernicama American Society of Clinical Oncology (ASCO) i American Society of Hematology (ASH), na prvom mjestu lijekova za liječenja anemije maligno oboljelih eritropoetin koji se koristi već dugo godina u svijetu, no u Republici Hrvatskoj njegova primjena nije još zaživjela.Anemia in malignant disease occurs with great frequency and its prevalence is 20-60% and depends on a number of diff erent factors. Causes of anemia in malignant disease can be manifold as they are already very presence of malignant disease, therapy of malignant diseases and various other conditi ons (infecti ons, nutriti onal defi cits, the presence of other chronic diseases, etc.). The presence of anemia in malignant disease negatively affects on all physiological systems and their functi ons, especially on the central nervous system, cardiorespiratory system and on renal functi on. Therefore, these patients feel much worse than the disease itself is caused, and the presence or absence of anemia aff ects on the choice of opti ons and ways of treatment and is also one of the prognostic factors for survival in many tumors. Although it is very common, the anemia of malignant disease is often overlooked and underesti mated, and only about 40% of cancer pati ents who have anemia receive therapy for anemia. For the preventi on and treatment of anemia in cancer patients it is necessary to eliminate underlying ethyological factors. Applicati on of erythropoetic agents is strongly recomended according to the guidelines of ASCO and ASH. Altough it has been used for many years in the world, in the Republic of Croatia erythropoetin has not been recognized for that indication