Haematological conditions frequently complicate cancer treatment, most commonly with reduced blood counts. Anaemia is common, and may respond to specific therapy with iron, or other haematinic therapy, immune suppression or erythropoietin, when there is an appropriate underlying cause. Whilst erythropoietin improves quality of life during chemotherapy, emerging evidence on the potential risks of erythropoietin in cancer patients needs to be weighed against the risks of transfusion support and where appropriate, non-pharmacological interventions should be considered.
Neutropenia is usually encountered as a complication of chemotherapy and increases the risk of sepsis. Granulocyte colony stimulating factor is widely available to assist in the prevention or management of neutropenia, but is not warranted in all cases. Cytokines directed at megakaryocytes have been used in chemotherapy-induced thrombocytopenia, but complications have limited their clinical development. Recent years have seen the emergence of promising thrombopoietin analogues, which may improve the management of thrombocytopenia into the future. At present, transfusion remains the mainstay of treatment for thrombocytopenia and coagulopathies, and should be given in accordance with evidence based guidelines.
