Etiopathogenesis of Cancer Related Anemia in Children and Adolescents with Malignant Solid Tumors

Abstract Background Anemia in cancer patients is a common comorbidity at diagnosis and throughout treatment, which is not solely due to the antineoplastic therapy; but it is multifactorial in origin. Anorexia, malnutrition and lack of specific components (such as iron, vitamins, folic acid, etc.) fundamental for erythropoiesis contribute to the multifactorial pathogenesis of anemia. Cancer related anemia (CRA) is primarily caused by the chronic inflammation associated 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 inflammatory mediators contributing to CRA. Aims To evaluate IL 6 levels and iron status among solid tumor children and adolescents presenting with a provisional diagnosis of CRA. Methods A 6 months cross sectional study included 30 patients with solid tumors and anemia following at the Hematology/Oncology Clinic, Ain Shams University. Detailed review of the patients' clinical and laboratory data of disease diagnosis, stage at diagnosis, daily iron intake assessed by food frequency questionnaire (FFQ), bone marrow biopsy results were studied. IL6 assay by ELISA, as well as serum ferritin, transferrin saturation index (TSI) were done upon anemia presentation. Results Thirty patients with Solid Tumors were recruited with median (IQR) age of 6 (2.5-10) years at presentation, The most common solid tumors among enrolled patients were brain tumors and neuroblastoma representing 26.7 % (n = 8) & 23.3 % (n = 7) respectively. The mean±SD hemoglobin was 9.21±1.33, among which 80% (n = 24) showed inadequate 24 hrs iron intake. After correlating serum ferritin to TSI levels, Nineteen patients (63.3%) had functional iron deficiency anemia, while 36.7% (n = 11) had combined true and functional iron deficiency anemia. IL 6 median (IQR) level was = 88.6 (57.5-156.5), which showed no statistically significant difference (p = 0.561) among patients with true and functional iron deficiency. Conclusion Anemia among cancer patient’s can be multifactorial with some patients experiencing true iron deficiency anemia, functional or combined true and functional iron deficiency anemia. IL 6 is elevated in cancer patients, yet was not reflected on patient’s body iron status.