[Diagnostic approach to the anemic cancer patient]

The anemia of the neoplastic patient can be: the first sign of a yet unknown neoplasia; a sign of progressive disease; an effect of therapy. The hemochromocytometric will define if the anemia is normocytic, microcytic or macrocytic. The reticulocyte counts will define the degree of marrow erythrocyte production. Thus specific algorithms could be used for trying to define the origin of the anemia. On the basis of the patient history, physical examination and other ad hoc exams it will be possible to determine the origin of the anemia keeping into mind the types of anemia of the neoplastic patients: anemia due to damage of the erythron as a consequence of chemotherapy; anemia of chronic disorders with a multiple pathogenesis. A decreased EPO production is often relevant; anemia due to renal damage (platinum compounds, anfotericin B) with decreased EPO production. A correct approach will allow the identification of the cause of the anemia and a correct treatment. Serum EPO determination can be useful to decide for EPO administration.