Etiopathogenesis of Cancer-Related Anemia among Children and Adolescents with Malignant Solid Tumors
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- Category: Vol. 92, December 2024
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Etiopathogenesis of Cancer-Related Anemia among Children and Adolescents with Malignant Solid Tumors, IMAN AHMED RAGAB, MENNA ALLAH ZAKARIA MOHAMMAD ALI ABOU ELWAFA, AYA TALLAH IBRAHIM ABDEL ALEIM, MARWA WAHEED ABD EL AAL TOLBA and SALWA MOSTAFA ABD EL KADER
Abstract Background: Anemia in cancer patients is a common co-morbidity at diagnosis and throughout treatment, which does not appear to be a consequence of concurrent antineoplastic therapy, rather than being multifactorial. Anorexia, Malnutri-tion and lack of specific components (such as iron, vitamins, folic acid, etc.) fundamental for erythropoiesis contribute to the multifactorial pathogenesis of anemia. Caner related anemia (CRA) is primarily caused by the chronic inflammation asso-ciated with the cancer pathogenesis, as cancer cells mediate the activation of immune cells particularly the macrophages increasing the secretion of interleukin-6 (IL-6) among other in-flammatory mediators contributing to CRA. Aim of Study: To evaluate IL 6 levels among children and adolescents presenting with suspected solid tumors induced CRA, as well as recognition of iron status and other possible causes of anemia in pediatric malignant solid tumors. Patients and Methods: A cross sectional study included 30 patients with solid tumors and anemia following at hematology/ oncology clinic, Ain Shams University. Detailed review of the patient’s clinical and laboratory data of disease diagnosis, stage at diagnosis, daily iron intake, bone marrow biopsy results, and IL6 assay by ELISA, as well as serum ferritin, transferrin satu-ration index (TSI) were done upon anemia presentation. Results: Thirty patients with Solid Tumors were recruit-ed with median (IQR) age of 6(2.5-10) years at presentation, 26.7% (n=8) diagnosed with brain tumors and 23.3% (n=7) with neuroblastoma. The Mean±SD hemoglobin was 9.21±1.33 g/dL, among which 80% (n=24) showed inadequate 24 hrs. iron intake. Nineteen patients (63.3%) had functional iron deficien-cy anemia, while 36.7% (n=11) hadcombinedtrue and function-al iron deficiency anemia. IL 6 median (IQR) level=88.6pg/mL (57.5-156.5), which showed no statistically significant differ- ence (p=0.561) among patients with true and functional iron deficiency. Conclusion: Anemia among cancer patients can be multi-factorial with some of patient’s experiencing true iron deficien-cy anemia that can be managed by proper dietetic iron supple-mentation, Yet CRA represents a state of chronic inflammation with functional iron deficiency that needs proper recognition.