Anaemia In Cancer


Anaemia in Cancer

Red blood cell background

  • WHO defines anaemia as a haemoglobin concentration less than a specified cut-off point.
  • The cut-off point is determined by factors such as age, gender, physiological status, smoking habits, and altitude at which the population is evaluated.
  • Age, sex and race-specific nomograms are used.
  • Anaemia is classified as mild, moderate, severe and very severe depending on these references.
  • Prevalence of anaemia in cancer patients depends on the cut-off chosen for classifying anemia.
  • Anaemia prevalence also varies with the type of malignancy.
  • It is more common in hematological malignancies (72%) than in solid tumors (66%).
  • Causes of anaemia in cancer can be:
    • Inadequate production of RBCs
    • Increased destruction of RBCs
    • Bleeding
  • Mechanism of anaemia can be disease-related, therapy related or concomitant factors.
  • Disease-related mechanism can be due to production of cytokines or other factors like bone marrow infiltration.
  • Treatment-related mechanism can be due to chemotherapy, radiotherapy or other drugs. It can be transient or sustained.
  • Most common symptoms of anemia in cancer is fatigue.
  • Different studies have shown decreased survival with cancer disease with presence of anaemia.
  • However, anaemia can also indicate advanced disease in hematological malignancies.
  • Anaemia can cause decrease in effect of chemotherapy and radiotherapy due to tissue hypoxia.
  • Since the anaemia in a cancer patient can be multifactorial, the aim of investigation is to rule out correctable causes:
    • Complete blood count
    • Reticulocyte count
    • Peripheral blood smear
    • Nutritional evaluation e.g. Iron studies
    • Hemolysis: DCT, ICT
    • Bone marrow examination
    • EPO estimation
  • Treatment:
    • No single regimen
    • Varies according to causes and presentation
    • Red cell transfusion is needed in case of haemorrhage and severe symptoms.
  • Causes:
      • AIHA: steroids
      • Nutritional deficiency: supplementation
      • Erythropoietin (EPO) reduces the number of patients requiring blood transfusion.