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[Clinical Analysis of Anemia in Castleman Disease]
Dao-Ping Sun1,2, Li Wang1, Run Zhang1
1Department of Hematology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province People Hospital, Nanjing 210029, Jiangsu Province, China.
Insights
Anemia is common in Castleman disease (CD), particularly multicentric CD (MCD). Most cases resemble anemia of chronic disease (ACD) and improve with treatment of the underlying CD.
Area of Science:
- Hematology
- Oncology
- Immunology
Background:
- Castleman disease (CD) is a rare lymphoproliferative disorder with diverse clinical presentations.
- Anemia is a frequent comorbidity in CD, impacting patient outcomes and treatment strategies.
Purpose of the Study:
- To investigate the prevalence and characteristics of anemia in patients diagnosed with Castleman disease.
- To differentiate anemia types and evaluate therapeutic responses in CD patients.
Main Methods:
- Retrospective analysis of clinical data from newly diagnosed CD patients.
- Evaluation of anemia prevalence, types, and correlation with disease characteristics and inflammatory markers.
Main Results:
- Anemia was present in 39% of CD patients, predominantly mild and normocytic.
- Multicentric CD (MCD) showed a significantly higher incidence of anemia (85%) compared to unicentric CD (UCD) (10%).
- Anemia in CD was often associated with systemic inflammation, elevated inflammatory markers, and immune dysregulation, primarily resembling anemia of chronic disease (ACD).
Conclusions:
- Anemia is a common manifestation of Castleman disease, driven by inflammatory and immunologic mechanisms, particularly in MCD.
- While autoimmune hemolytic anemia (AIHA) can occur, ACD is the predominant type associated with CD.
- Effective management of anemia in CD relies on controlling the primary disease through appropriate systemic or surgical treatments.
Objective:
This study was to explore the characteristics of anemia in Castleman disease (CD).
Methods:
Clinical data were collected retrospectively to analyze the prevalence and characteristics of CD with anemia were analysed retrospectively, and different types of anemia and their therapeutic effects were evaluated.
Results:
Anemia was observed in 13/33(39%) newly diagnosed CD patients, most of them was mild and normocytic. Incidence of anemia in multicentric CD (MCD) was higher than that in unicentric CD (UCD) (85% vs 10%, P<0.001). Most of CD patients with anemia presented systematic manifestations; moreover, they had higher levels of erythrocyte sedimentation and inflammatory indices, higher incidence of polyclonal hyperimmunoglobulinemia, and higher positive rate of autoantibodies than those without anemia (P<0.05). Except for 2 cases of autoimmune hemolytic anemia (AIHA) and 1 case of anemia secondary to hypersplenism, the anemia in the other 10 patients exhibited features similar to anemia of chronic disease (ACD), whose hemoglobin levels were negatively correlated with the serum levels of C reactive protein and fibrinogen (r -0.917 and -0.717, respectively, P<0.001). Anemia in UCD was cured by the removal of tumor. Yet, anemia in MCD was improved after systemic treatment with immunotherapy and/or chemotherapy.
Conclusions:
anemia with an inflammatory and immunologic mechanism presents as a common symptom in MCD, but also can be observed in UCD. In addition to occasional AIHA, anemia associated with CD mainly presents characteristics of ACD. Treatment for anemia in CD is mainly based on the control of primary disease.
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