Gaspar Balan Louis, Sharma Prashant, Das Reena
Hematology. 2015 Jan;20(1):18-25. doi: 10.1179/1607845414Y.0000000161. Epub 2014 Mar 26.
The aim of this paper is to review the pathogenesis and diagnostic approaches to anemia in cancer patients.
PubMed was queried for various combinations of anemia and cancer-related terms using appropriate filters for articles and practice guidelines published in the last 5 years. Specific searches were conducted for individual pathogenetic mechanisms and malignancies of specific anatomic sites.
Anemia is the commonest hematological manifestation of cancer, afflicting 40-64% of patients treated for malignancies. Pathophysiologically, cancer-related anemia can be classified into four broad but overlapping categories: hypoproliferative anemia including the common anemia of inflammation/chronic disease, hemolytic anemia, miscellaneous etiologies, and uncertain etiologies. Anemia incidence increases with the administration of chemotherapy/radiotherapy. It reduces the quality of life and shortens survival in cancer patients. A positive correlation is observed between anemia and tumor hypoxia. Experimentally, hypoxemia enhances tumor growth and resistance to therapy by stimulating angiogenesis, acquisition of genomic mutations, and increasing resistance to apoptosis as well as to the killing effects of chemo/radiotherapy-generated free radicals.
Diagnostic approaches to the anemic cancer patient begin with a detailed clinical history and physical examination. Peripheral blood morphology and reticulocyte count are also helpful. Patients with unexplained anemia are evaluated by standard approaches also used in patients of similar age without malignancy. Serum iron profile and bone marrow examination are often required in difficult cases. This review focuses on major aspects of the pathogenesis of the individual entities. Diagnostic approaches and uncommon causes including hemophagocytic lymphohistiocytosis, acquired hemoglobinopathies, and myelodysplasia are also discussed.
本文旨在综述癌症患者贫血的发病机制及诊断方法。
使用适当的筛选条件，在PubMed中查询过去5年发表的关于贫血与癌症相关术语的各种组合，包括文章和实践指南。针对特定的发病机制和特定解剖部位的恶性肿瘤进行了具体搜索。
贫血是癌症最常见的血液学表现，40%-64%接受恶性肿瘤治疗的患者受其困扰。在病理生理学上，癌症相关贫血可分为四大类，但有重叠：增生低下性贫血，包括常见的炎症/慢性病贫血、溶血性贫血、其他病因及病因不明的贫血。贫血发生率随化疗/放疗的进行而增加。它降低了癌症患者的生活质量并缩短了生存期。贫血与肿瘤缺氧之间存在正相关。在实验中，低氧血症通过刺激血管生成、获得基因组突变以及增加对凋亡的抵抗以及对化疗/放疗产生的自由基的杀伤作用，从而促进肿瘤生长和对治疗的抵抗。
对贫血癌症患者的诊断方法始于详细的临床病史和体格检查。外周血形态学和网织红细胞计数也有帮助。不明原因贫血的患者采用与年龄相仿的非恶性肿瘤患者相同的标准方法进行评估。疑难病例通常需要进行血清铁检查和骨髓检查。本综述重点关注各个实体发病机制的主要方面。还讨论了诊断方法和罕见病因，包括噬血细胞性淋巴组织细胞增生症、获得性血红蛋白病和骨髓增生异常综合征。
