Abstract:
Anemia has and will continue to be a central theme in medicine particularly as clinicians are treating a burgeoning population of complex multiorgan processes. As a result of multiple randomized controlled trials (RCA), meta-analyses, and medical societal recommendations overly restrictive paradigms and under-administration of erythropoiesis stimulating agents (ESA) have likely been followed by clinicians among all specialties. A review of anemia in the context of chronic kidney disease (CKD), hematologic malignancies, and cancer is presented with focus on the establishment of ESAs as integral in the treatment of anemia. RCTs and meta-analyses studying the use of ESAs are presented with focus upon their application to clinical practice. A compendium will be presented describing the evolution, establishment, and implications of ESA administration initially among those with CKD with rapid subsequent application to the hematology-oncology population of patients. Upon evaluation of the risks and benefits of ESAs focused critique is made supporting more liberal use of these agents strongly suggesting that the current underlying treatment ‘pendulum’ has perhaps shifted too far to the ‘under-treatment’ side in many individual cases. In addition, a parallel critique will be made in favor of liberalizing the strict transfusion criteria among selected renal and oncology patients who generally present with multiple comorbid conditions.
