Biological basis of anemia

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Abstract

Anemia is a frequent complication in cancer, occurring in more than 50% of patients with malignancies. Several factors can cause anemia in these patients, such as blood loss, hemolysis, bone marrow infiltration, hypersplenism, and nutrient deficiencies. However, in a considerable number of patients, no cause other than malignant disease itself can be implicated. This cancer-related anemia is similar to the anemia observed in other chronic diseases, such as rheumatoid arthritis and some chronic infections. The syndrome of anemia of chronic disease is characterized by a hyporegenerative, normocytic, normochromic anemia associated with reduced serum iron and transferrin saturation but elevated (or normal) ferritin levels. Cancer-related anemia results from activation of the immune and inflammatory systems, leading to increased release of tumor necrosis factor, interferon-gamma, and interleukin-1. The cytokine-mediated relative failure of erythropoiesis has been further investigated, and three different mechanisms of action are proposed: (1) impaired iron utilization; (2) suppression of erythroid progenitor cells differentiation; and (3) inadequate erythropoietin production. In addition, the life span of red blood cells is shortened in cancer-related anemia and production cannot compensate sufficiently for the shorter survival time. Administration of recombinant human erythropoietin (r-HuEPO, epoetin alfa) can not only correct inadequate endogenous erythropoietin production, but also can overcome the suppression of erythroid progenitor cells and impairment of iron mobilization.

References (36)

  • GD Demetri et al.

    Quality-of-life benefit in chemotherapy patients treated with epoetin alfa is independent of disease response or tumor type: Results from a prospective community oncology study. Procrit Study Group

    J Clin Oncol

    (1998)
  • TJ Littlewood et al.

    Effects of epoetin alfa on hematologic parameters and quality of life in cancer patients receiving nonplatinum chemotherapy: Results of a randomized, double-blind, placebo-controlled trial

    J Clin Oncol

    (2001)
  • JP Doweiko et al.

    Erythropoietin therapy in cancer patients

    Oncology

    (1991)
  • N Beru et al.

    Expression of the erythropoietin gene

    Mol Cell Biol

    (1986)
  • MC Bondurant et al.

    Anemia induces accumulation of erythropoietin mRNA in the kidney and liver

    Mol Cell Biol

    (1986)
  • AJ Erslev

    Erythropoietin

    N Engl J Med

    (1991)
  • E Sundal et al.

    Correction of anaemia of chronic renal failure with recombinant human erythropoietin: Safety and efficacy of one year's treatment in a European multicentre study of 150 haemodialysis-dependent patients

    Nephrol Dial Transplant

    (1989)
  • RW Evans et al.

    The quality of life of hemodialysis recipients treated with recombinant human erythropoietin. Cooperative Multicenter EPO Clinical Trial Group

    JAMA

    (1990)
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    Prof Bron has received honoraria from Ortho Biotech and Janssen-Cilag.

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