Bone Marrow Toxicity: Red Blood Cells

The bone marrow is a major target of chemotherapy agents due to its high proliferative capabilities. Anemia is a common manifestation in patients with cancer. Its cause can be multifactorial: the cancer itself, chemotherapy treatments, infiltration of bone marrow by cancer cells, hemolysis, nutritional deficiencies, blood loss, and inflammation, among others. Anemia impacts the quality of life of cancer patients, and it can compromise their compliance with chemotherapy treatments. We have different options to correct chemotherapy- or cancer treatment–induced anemia: red blood cell (RBC) transfusions, iron, and erythropoiesis-stimulating agents (ESAs). In this chapter, we analyze these different options: red blood cell transfusions, iron (oral and intravenous), and erythropoietic stimulating agents (ESAs). Their use and indications, how to administer them and their safety.