Elevation of serum alpha-fetoprotein in anemic patients

Alpha-fetoprotein (AFP) is present in the serum of normal healthy adults; an increase in level has been found as a rule in patients with diseases that can affect the liver. In the course of routine examination, we encountered a moderate increase in serum AFP in some patients with acute bleeding anemia, not accompanied by elevation of serum transaminase levels. We examined the relationship between anemia and serum AFP levels, using CIS kits for the assay. The least detectable concentration of below 0.25 ng/ml, which was two standard deviations outside the value obtained for the zero-dose response, was measurable by a two-step incubation: pre-incubation of serum and antiserum followed by addition of [125I]AFP and further incubation. The mean AFP level in 75 normal control sera was 2.4 1.6 ng/ml. There was a significant increase in the mean value of serum AFP levels in acutely anemic patients with no evidence of liver involvement. The increase was moderate, many of the patient samples being within the normal range. The reticulocyte counts did not correlate with the elevated AFP levels, indicating low significance of extra-hepatic AFP synthesis. A moderate increase in AFP production might occur in acutely anemic patients with no detectable hepatic cell damage.