Cancer

Understanding the Link Between Cancer Disease and Anaemia

anaemia in cancer

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.
The prevalence of anaemia in cancer patients depends on the cut-off chosen for classifying anaemia.
Anaemia prevalence also varies with the type of malignancy.
It is more common in haematological malignancies (72%) than in solid tumours (66%).
Causes of anaemia in cancer can be:
- Inadequate production of RBCs
- Increased destruction of RBCs
- Bleeding
Mechanisms 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 mechanisms can be due to chemotherapy, radiotherapy or other drugs. It can be transient or sustained.
The most common symptom of anaemia in cancer is fatigue.
Different studies have shown decreased survival with cancer disease with the presence of anaemia.
However, anaemia can also indicate advanced disease in haematological malignancies.
Anaemia can occur in the effect of chemotherapy and radiotherapy due to tissue hypoxia.
Since the anaemia in a cancer patient can be multifactorial, the aim of the 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.