Daniele E, Foti G
Servizio di Medicina Generale, Ospedale G. Eastman, Roma.
Minerva Stomatol. 1997 Dec;46(12):665-9.
The authors related about a peculiar form of anemia found in some patients operated on oral cancer; these patients had an almost normal hematic situation before their operation. 63 patients, operated in the course of a year for oral cancer, have been studied by the authors; they have found in 14 cases (22.2%) a light anemia which regressed after a self blood transfusion, during the first week after the operation; in other 8 cases (12.7%) the anemia, which was more serious, persisted beyond the 7th day after the operation. Those 8 patients, suffering from more serious and persistent anemia, were treated from 7th to 21st day after the operation with iron, vitamin B12 and folic acid without any improvement. The hematic situation improved about 10 days after the end of treatment, probably as a result of spontaneous renewal of medullar haemopoietic activity. This anemia, is characterized by normochromia, normocytosis, reduced response of reticulocytes, sideropenia and hyperferritinaemia. The authors think that the pathogenesis of anemia after operation in neoplastic patients is caused by medullary insufficiency existing before the operation, connected with reduced erythropoietin production and emphasized by an operation that sometimes cause bleeding. Consequently the authors hypothesis the use of erythropoietin in the therapy of most severe anemia in neoplastic operated patients.
作者讲述了在一些接受口腔癌手术的患者中发现的一种特殊形式的贫血;这些患者在手术前血液状况几乎正常。作者对63例在一年内接受口腔癌手术的患者进行了研究;他们发现14例(22.2%)有轻度贫血,在术后第一周自体输血后贫血消退;另外8例(12.7%)贫血较为严重,在术后第7天之后仍持续存在。那8例患有更严重且持续贫血的患者在术后第7天至21天接受了铁、维生素B12和叶酸治疗,但没有任何改善。治疗结束约10天后血液状况有所改善,可能是由于骨髓造血活动自发恢复。这种贫血的特征是正色素性、正常红细胞性、网织红细胞反应降低、缺铁和高铁蛋白血症。作者认为肿瘤患者术后贫血的发病机制是术前存在的骨髓功能不全,与促红细胞生成素生成减少有关,且手术有时导致出血会加重这种情况。因此,作者推测在接受手术的肿瘤患者最严重贫血的治疗中使用促红细胞生成素。