![]() Further investigation and an evidence-based standardized approach to testing is recommended. This challenges the current recommendations and has implications for accurate diagnosis and management. In this study we found that prolonged overnight fasting was in fact associated with higher serum iron concentrations compared with post-prandial testing. Conclusions: As recommended in current NCCN guidelines, most patients with cancer who have anemia undergo testing after overnight fasting. There was variation in transferrin levels between both states but the trend was not significant. A review of current research on iron levels provides biological plausibility for this finding. ![]() Surprisingly, there was a significant trend towards higher serum iron levels with fasting studies when compared with post-prandial testing. Results: Our study included 50 patients with anemia (25 cases with active malignancy and 25 controls without malignancy). Descriptive statistics were used to analyze data. We excluded any patient with transfusion, hemoglobinopathy, iron overload, IV iron administration, hemolysis or bacteremia during the study period. Each patient had undergone iron studies in both the fasting (overnight) and post-prandial states with a maximum of 30 days between testing. Methods: We identified a cohort of patients who were evaluated for anemia. In this study, we investigate the hypothesis that post-prandial iron testing results in falsely elevated levels, underestimating iron deficiency. National Comprehensive Cancer Network (NCCN) revised guidelines on Cancer- and Chemotherapy-Induced Anemia (2018) state that to prevent falsely elevated levels, serum iron and total iron-binding capacity should be done in the fasting state. The accurate investigation of iron status in these patients is key to diagnosis, assessment of severity and treatment (oral or IV iron or ESA’s). Please show your mask exemption card and appointment letter to staff at the entrance. Iron deficiency anemia: Blood smear: anisopoikilocytosis (RDW), hypochromia and microcytosis, often thrombocytosis. Mask exemptions accepted for people seeking treatment Any member of the public with a mask exemption is welcome in all our facilities when attending to receive health care and treatment. The severity of anemia correlates with quality of life and can worsen performance status leading to poorer outcome. The first step is obtaining iron studies and peripheral blood smear to differentiate between iron deficiency anemia (most common) and anemia of chronic disease or other causes. It has been reported in 32-60% of patients with cancer. The HFE gene test is useful in confirming the diagnosis of hereditary hemochromatosis, screening adult family members of patients with HFE mutations and resolving ambiguities concerning iron overload.Background: Iron deficiency anemia in patients with cancer is a frequent complication that may be present at diagnosis and worsen with disease. Between 60 and 93 percent of patients with the disorder are homozygous for a mutation designated C282Y. Hereditary hemochromatosis is associated with mutations in the HFE gene. Life expectancy is usually normal if phlebotomy is initiated before the development of cirrhosis or diabetes mellitus. The diagnosis is based on a combination of clinical, laboratory and pathologic findings, including elevated serum transferrin saturation. ![]() Increasingly, however, hereditary hemochromatosis is being diagnosed at an earlier, less symptomatic stage. Previously, the classic description was combined diabetes mellitus, cutaneous hyperpigmentation and cirrhosis. It is characterized by increased intestinal absorption of iron, with deposition of the iron in multiple organs. Hereditary hemochromatosis is the most common inherited single-gene disorder in people of northern European descent. ![]()
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