Anemia in malignancies: pathogenetic and diagnostic considerations

Area of Science:

• Hematology
• Oncology
• Pathophysiology

Background:

• Anemia is the most frequent hematological complication in cancer patients, affecting 40-64% of those with malignancies.
• Cancer-related anemia negatively impacts patient quality of life and survival rates.
• Anemia is positively correlated with tumor hypoxia, which can promote tumor growth and therapeutic resistance.

Purpose of the Study:

• To review the pathogenesis of anemia in cancer patients.
• To outline diagnostic approaches for anemia in cancer patients.

Main Methods:

• A comprehensive literature search was conducted using PubMed.
• Searches included combinations of anemia and cancer-related terms, filtered for recent articles and guidelines.
• Specific searches focused on pathogenetic mechanisms and specific cancer types.

Main Results:

• Anemia in cancer patients can be categorized into hypoproliferative (including anemia of inflammation/chronic disease), hemolytic, and other/uncertain etiologies.
• Anemia incidence rises with chemotherapy and radiotherapy, exacerbating negative patient outcomes.
• Tumor hypoxia, linked to anemia, enhances tumor growth, angiogenesis, and resistance to apoptosis and therapy.

Conclusions:

• Diagnostic evaluation for anemia in cancer patients starts with clinical history and physical examination.
• Peripheral blood morphology, reticulocyte count, serum iron profile, and bone marrow examination aid diagnosis.
• Uncommon causes like hemophagocytic lymphohistiocytosis, acquired hemoglobinopathies, and myelodysplasia require specific diagnostic considerations.