Iron deficient erythropoiesis might play key role in development of anemia in cancer patients

// Silvia Park 1 , Chul Won Jung 1 , Kihyun Kim 1 , Seok Jin Kim 1 , Won Seog Kim 1 , Jun Ho Jang 1 1 Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea Correspondence to: Jun Ho Jang, e-mail: smcjunhojang@gmail.com Keywords: cancer, anemia, soluble transferrin receptor, hepcidin Received: July 19, 2015      Accepted: October 13, 2015      Published: October 26, 2015 ABSTRACT Introduction: Multifactorial pathogenesis is involved in anemia of cancer patients and defining the causes of anemia is not always simple. Methods: The incidence of anemia among 4 major cancers (gastric, colorectal, lung cancer and hepatocellular carcinoma), and biochemical features of anemia using ferritin, CRP, hepcidin and soluble transferrin receptor (sTfR) were assessed. Anemia was defined either by hemoglobin (Hb) ≤11 g/dL or a drop of Hb 2 g/dL or more during anticancer treatment. Results: Among the 345 patients including 152 lung cancer, 101 gastric cancer, 69 colorectal cancer and 23 hepatocellular carcinoma, 49 patients (14.2%) had anemia at their initial diagnosis of cancer. During treatment, 129 (37.4%) experienced anemia, and 34 (26.4%) were treated mostly by transfusion. Biochemical feature of anemia was examined with 39 patients’ samples. When comparing to the reference value from general population, cancer patients showed numerically higher ferritin, sTfR, CRP and hepcidin level. Among the cancer patients, anemic patients had significantly higher ferritin ( p = 0.050) and sTfR ( p = 0.009) level compared to non-anemic patients. Conclusion: Anemia is a common issue in cancer patients and is largely undertreated with sub-optimal diagnoses of cause. The rates of anemia increase significantly during anti-cancer treatment and appear to be largely associated with iron deficiency.