A transfusion medicine physician in South Africa reports that in a Commentary in Transfusion, Vol 39, Sept 1999, L.T.Goodnough described a transfusion medicine specialist and scope of responsibility which includes development of blood conservation. She is using his prototype as a model in terms of providing services by the East Coast Region of South Africa National Blood Services. Therefore, she has taken responsibility for the Predeposit Autologous Donation Program. It is in this context that she wishes to present the following clinical scenario.

A number of patients (8-10) with cancer of the prostate have participated in a local autologous blood donation program. Almost without exception their prostate cancer diagnosis was suspected following surveillance of PSA as part of annual medical evaluations, so that these patients were completely asymptomatic. On presentation all had normal hemoglobin levels (>12.5 gm/dL). Provided there are no contraindications, patients on the program receive iron supplements. Drawing on her experience as a hematopathologist (she worked in an academic center that is the major referral center for the whole of Kwazulu Natal and parts of the Eastern Cape), she decided not to administer iron to these patients. This decision arose out of the observation that in marrow aspirates accompanied by a normal hemoglobin levels submitted for staging for a variety of malignancies the iron status was invariably that seen in the anemia of chronic disease (i.e., normal to increased iron stores with sideroblast count < 20%). She would like to know how other colleagues would approach this clinical situation.

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Ira A. Shulman, MD
CBBS e-Network Forum Editor & Moderator