الفهرس 
Childhood cancerOnly 14 pages are availabe for public view
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Abstract
Cancer-related anemia may be charac¬terized as anemia of chronic disease, mediated by inflammatory cytokines that have a direct inhibi¬tory effect on erythropoiesis and may inhibit the production of erythropoietin. Other causes of ane¬mia in patients with cancer include chemotherapy, radiation therapy, nutritional factors, and bleeding associated with gastrointestinal or genitourinary malignancies. Anemia results in a series of symptoms that can influence the physical and functional status of patients, negatively affecting their treatment and quality of life.
The term functional iron deficiency (FID) has been applied to the situation characterized by iron-restricted erythropoiesis in the presence of iron stores. This is an additional cause of anemia in patients with various chronic diseases including cancer.
The aim of the current study was to evaluate the etiology of anemia in cancer patients in relation to the iron status and the prevalence of iron restricted erythropoeisis.
This study was performed at the Pediatric Hematology/Oncology Unit, Children’s hospital, Ain-Shams Universityin the period from March 2012 to April 2013. It included 40 patients with childhood cancer with anemia.
All patients in this study were subjected to the following:
History including:age, sex, anemia symptoms, dietary intake, cachexia, weight pre diagnosis, weight post, daily caloric intake, stool motion, vomiting, blood loss, blood transfusion in previous month, complications of blood transfusion, cancer: type and date of diagnosis, medication of cancer, duration of cancer therapy, systemic symptoms, medication of anemia.
Physical examination included CVS and CNS signs suggestive of anemia.
Performance status scale/score Karnofsky and Lansky were performed.
Laboratory Analysis includedCBC, reticulocyte %, absolute reticulocytic count, iron profile: serum iron, serum ferritin, total iron binding capacity, transferrin saturation, CRP, reticulocyte hemoglobin content.
Patients were classified into 4 categories according the level of transferrin saturation (Tsat) and RET-He content. Category 1:29(72.5%) with no iron deficiency (Tsat >20%) and no FID (RET-He>29pg); category 2: 1(2.5%) iron deficiency (Tsat<20%) and no FID (RET-He>29pg); Category 3: 2(5%)replete iron (Tsat>20%) and FID (RET-He ≤29pg) and category 4: 8 (20%) both levels below cutoff: Iron deficiency anemia. Patients with proved iron deficiency were given oral iron therapy with a dose of 6 mg/kg for 6 weeks.
Results of the current study showed that no significance between cancer patients with and without FIDA regarding age (p=0.556), gender (p=0.253), cancer type (p=0.161), CVS symptoms (palpitation) (p=0.432), CNS symptoms (fatigue, irritability and lack of concentration) (p=1.000), cachexia (p=1.000), heart rate (p=0.379) and performance status score (p=0.648).
Significant higher number of blood transfusions and irritability in cancer patients with FIDA compared to cancer patients with Non FIDA(p=0.049 & 0.015 respectively). No significance difference between organomegaly (hepatosplenomegaly) or evidence of infection (p=0.404 & 1.000 respectively).
Significant lower MCV (87, p=0.043), MCHC (87, p=0.043), serum iron (87, p=0.043) and transferrin saturation (33, p=0.046) in cancer patients with FIDA compared to cancer patients with Non-FIDA.
Significant increase in Lansky score in cancer patients with FIDA after treatment (80, p=0.024). Significant increase in Hb (12, p=0.028) and reticulocyte percentage level (2.1, p=0.043) in cancer patients with FIDA after treatment with significant decrease in TIBC level in cancer patients with FIDA after treatment (215.5, p=0.028).
Significant correlation between reticulocyte Hb content and Hb (p=0.001), MCV (p=0.002), MCH (p=0.008) and MCHC (p=0.002) were detected. However no significant correlation between reticulocyte Hb content and serum iron, serum ferritin, TIBC and transferrin saturation were detected