Version July 2025
| Assessment/laboratory test | Alternate cause of anemia/rationale | |
| Appropriate for all patients | Thorough drug exposure history | Drug-induced anemia is common in patients with cancer. As examples:
|
| Iron studies (ferritin, iron, TIBC, calculated TSAT) | Iron deficiency must be identified and corrected if present before starting an ESA. For patients with active cancer, a ferritin <100 ng/mL or TSAT <20% requires treatment with iron. | |
| Baseline EPO level | Helpful in predicting response to an ESA. | |
| Kidney function testing | Kidney function will be known in most cancer patients on active treatment. | |
| Appropriate for selected patients | TSH | Thyroid dysfunction can cause macrocytic anemia. |
| Vitamin B12 and folate | Vitamin B12 or folate deficiency can cause macrocytic anemia. | |
| Hemolysis testing (reticulocyte count, haptoglobin, LDH, bilirubin) | Causes of hemolytic anemia in patients with cancer may include:
| |
| Coombs testing | For patients with evidence of hemolysis, Coombs testing can determine if it is immune or non-immune. Especially relevant in patients with a history of autoimmune disease or an underlying condition associated with AIHA such as SLE. | |
| Testing for hereditary anemias (eg, hemoglobinopathies) | Not required if previous hemoglobin values were normal. Reasonable for a patient with lifelong unexplained anemia. | |
| Review of peripheral blood smear | Especially important for unexplained anemia (new onset or chronic) or if WBC and/or platelet counts are abnormal. | |
| Bone marrow examination | May be relevant if there is a myelophthisic picture or bone marrow involvement by cancer is suspected. |
