Table 7.

Presentation and management of severe anemia.

Syndrome	Presentation	Management
Severe anemia	❖Symptoms: debilitating fatigue and dyspnea, initially with exertion then at rest	❖Laboratory exams: reticulocyte count and haptoglobin, iron studies, serum vitamin B12 and folate levels, liver function tests (including albumin, prealbumin, total and direct bilirubin) and lactate dehydrogenase concentrations, as well as a peripheral blood smear, should be obtained in addition to the complete blood count ❖Hemagglutinins can be assessed to rule out hemolysis ❖Transfusion should be used as sparingly as possible and should target a hemoglobin level of 7.0 mg/dL unless the patient has established cardiac disease or continues to be overtly symptomatic where 8.0 mg/dL is appropriate ❖Erythropoiesis-stimulating agents are no longer indicated for cancer-related anemia