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Table of Contents
Year : 2021  |  Volume : 4  |  Issue : 1  |  Page : 164-165

Anemia in treatment-naive patients with cancer

Department of Pathology, North Bengal Medical College, West Bengal University of Health Science, Darjeeling, West Bengal, India

Date of Submission02-Feb-2021
Date of Decision03-Mar-2021
Date of Acceptance04-Mar-2021
Date of Web Publication26-Mar-2021

Correspondence Address:
Bidyut Krishna Goswami
Department of Pathology, North Bengal Medical College, West Bengal University of Health Science, Darjeeling - 734 012, West Bengal
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/crst.crst_27_21

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How to cite this article:
Goswami BK. Anemia in treatment-naive patients with cancer. Cancer Res Stat Treat 2021;4:164-5

How to cite this URL:
Goswami BK. Anemia in treatment-naive patients with cancer. Cancer Res Stat Treat [serial online] 2021 [cited 2021 Jun 24];4:164-5. Available from: https://www.crstonline.com/text.asp?2021/4/1/164/312073

Establishing the diagnosis of anemia is of paramount importance for patients with cancer.[1] About 32–49% of the patients with cancer have anemia at the time of diagnosis, depending on the type of cancer.[2] Additionally, about 50% of the patients develop anemia at some point of time during the course of the disease. Multiple possible etiologic factors, either alone or in combination, such as the type of cancer, underlying medical issues, and the ensuing therapy, are thought to be involved in the development of anemia.[3] Anemia may result in these patients from a combination of cancer-related and non-cancer-related causes. Non-cancer-related factors such as hemolysis, bleeding, hemoglobinopathies, nutritional deficiencies, or infections may contribute to or aggravate an already existing anemia in treatment-naïve patients with cancer.[1],[2] Activation of the immune system through the secretion of inflammatory cytokines, analogous to anemia of chronic disease, and other causes such as cytokine production by tumor cells, shortened red blood cell survival due to inflammatory cytokines,[3] and chronic blood loss at the site of the tumor, can aggravate cancer-related anemia. Anemia can also occur due to bone marrow invasion in patients with leukemia or other solid malignancies. About 50% of the patients with hematological malignancies present with anemia at the time of cancer diagnosis, whereas only one-third of the patients with solid malignancies present with anemia at diagnosis.[1] Therefore, health-care professionals must always be vigilant about anemia in patients with cancer.

The study by Pandey et al.[4] on the prevalence of iron and vitamin B12 deficiencies and inflammatory anemia in treatment-naive patients with cancer deserves praise for several reasons. Apart from being the first of its kind, this study depicts a very basic need of the day-to-day oncology practice. The quality of life of patients with cancer can be improved from the knowledge gathered from the findings of this study. This study is comprehensive, with an adequate number of patients with different cancer types, and has been able to establish a satisfactory statistical correlation.

However, in our opinion, a few important aspects could have been better addressed. By definition, the term prevalence is associated with a defined population during a specified time period in a geographical area,[5] and one hospital does not cater to all the patients in a defined geographical area. Therefore, the use of the term prevalence should have been avoided, and the term “occurrence” could have been used instead.

Additionally, we believe that serum iron should ideally be measured in the morning on an empty stomach to minimize variation,[6] and 12-h fasting samples are most preferred.

Data on anemia due to nutritional deficiencies are scarce in the literature,[7] and in the Indian scenario, testing the folic acid level (which has not been done in the current study and stated as one of the limitations) along with the serum iron status and vitamin B12 levels would have added more value.

Increased ferritin level is considered as a marker for inflammatory anemia. However, associated inflammation, not related to cancer, can also cause increased ferritin levels. Increased ferritin level or transferrin saturation (TSAT) may also be related to underlying hemolytic processes such as chronic hemolytic anemia or hemoglobinopathies (not uncommonly seen, with marginally low hemoglobin levels, in this part of country), which are neither excluded nor being reflected through related investigations for hemolytic anemia. Moreover, it is well established that testing for serum ferritin and TSAT is more helpful in identifying an iron deficiency.[6] Ferritin levels >300 mg/L and TSAT >20% may be indicative of inflammatory anemia, but cannot be the defining criteria for inflammatory anemia. Therefore, the definition of inflammatory anemia needs more study.

Additionally, the effects of supplementation on the anemia status and hematological parameters of these patients could have been documented as an important secondary outcome of this study. This could have served as a validation for the nutritionally-deficient state of these patients, and ultimately, would have made the management protocol more informative and productive for patients with cancer.

Hematolymphoid malignancies account for a considerable cancer burden and contribute significantly to cancer-related anemia. However, in this study, patients aged <18 years were not included, despite the high incidence of hematolymphoid malignancies in this age group. The rationale for excluding these patients is not clear.

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Conflicts of interest

There are no conflicts of interest.

  References Top

Marks PW, Rosenthal DS. Hematologic manifestations of systemic disease: Infection, chronic inflammation, and cancer. In: Hoffman R, Benz EJ, Silberstein LE, Heslop H, Furie B, McGlave P, et al., editors. Hematology: Basic Principles and Practice. 5th ed. Philadelphia, PA: Churchill Livingstone Elsevier; 2009. p. 2309-19.  Back to cited text no. 1
The NCCN Clinical Practice Guidelines in Oncology. Cancer- and Chemotherapy-Induced Anemia. Version 2. National Comprehensive Cancer Network; 2010. Available from: https://www.sabm.org/wp-content/uploads/2018/08/nccn_anemia_guidelines.pdf. [Last accessed on 2021 Mar 03].  Back to cited text no. 2
Birgegård G, Aapro MS, Bokemeyer C, Dicato M, Drings P, Hornedo J, et al. Cancer-related anemia: Pathogenesis, prevalence and treatment. Oncology 2005;68 Suppl 1:3-11.  Back to cited text no. 3
Pandey A, Aryan R, Krishna M, Singh S, Pankaj P. Prevalence of iron and Vitamin B12 deficiencies and inflammatory anemia in treatmentnaive patients with cancer: A cross sectional study. Cancer Res Stat Treat 2020;3:708-15.  Back to cited text no. 4
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Park K. Principles of epidemiology and epidemiologic methods. In: Park's Textbook of Preventive and Social Medicine. 24th ed. Jabalpur: Banarasidas Bhanot; 2017. p. 58-145.  Back to cited text no. 5
Dignass A, Farrag K, Stein J. Limitations of serum ferritin in diagnosing iron deficiency in inflammatory conditions. Int J Chronic Dis 2018;2018:9394060.  Back to cited text no. 6
Dhanuka A, Goswami BK, Goswami SB, Chakrabarti S. Profile of nutritional anemia and its correlation with serum iron, Vitamin B12, and folic acid level among the tribal population of northern districts of West Bengal, India. Arch Med Health Sci 2019;7:201-5.  Back to cited text no. 7
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