Anemia due to malignant tumor
Introduction
Introduction to anemia caused by malignant tumor Anemia caused by malignant tumor refers to anemia caused by various malignant tumors other than hematopoietic tissue. The type and degree of anemia manifested by different types, stages, and treatment methods of malignant tumors. The treatment of anemia caused by malignant tumors mainly depends on the treatment of tumors. For example, after surgery, chemotherapy, radiotherapy and biological treatment, if the tumor is cured or the therapeutic effect is clinically relieved, the anemia can be significantly improved or even disappeared. basic knowledge The proportion of illness: 15% Susceptible people: no special people Mode of infection: non-infectious Complications: microangiopathic hemolytic anemia
Cause
Causes of anemia caused by malignant tumors
(1) Causes of the disease
Various malignant tumors.
(two) pathogenesis
The formation mechanism of anemia of malignant tumor is complex, the type and simple mechanism of anemia caused by tumor.
1. Chronic disease Anemia Chronic disease Anemia is one of the causes of tumor-induced anemia, especially in patients with non-progressive tumors. It is more common as mild to moderate positive cell anemia, and its production mechanism is mainly related to hematopoietic progenitors. Cell function is reduced and is associated with low response to erythropoietin.
2. The occurrence of hemolytic anemia in patients with hemolytic anemia is related to the following factors:
1 Red blood cell life shortened Most patients with anemia tumors have a slight shortening of red blood cell life, which is related to the hyperfunction of mononuclear macrophage system. The red blood cells flow through the spleen. During the liver process, the cell membrane is continuously phagocytosed by mononuclear macrophages, causing premature erythrocytes. damage,
2 microvascular hemolytic anemia advanced tumors can be combined with disseminated intravascular coagulation, some gastric cancer, lung cancer can produce mucin, causing fibrin deposition in small blood vessels, leading to a mechanism similar to DIC, causing red blood cells to destroy in small blood vessels ,
3 autoimmune hemolytic anemia seen in patients with ovarian cancer, malignant lymphoma and lymphocytic leukemia, producing anti-self-erythrocyte antibodies, in patients with ovarian cancer combined with hemolysis, the production of antibodies are basically warm-type antibodies, ovarian tumors, anemia can be cured .
3. Pure red blood cell aplastic anemia patients with thymoma often have acquired pure red blood cell aplastic anemia (PRCA), the literature reports that about 7% to 50% of PRCA, a small number of lung cancer, breast cancer can also be combined with PRCA, thymoma and The PRCA relationship is closely expressed as:
1 removal of thymoma, half of the patients with PRCA can be cured,
2 There are anti-erythrocyte antibodies and erythropoiesis inhibitory factors in the serum of patients. This factor is IgG type, and it is effective to treat PRCA with immunosuppressant and anti-lymphocyte serum.
3 patients often accompanied by other abnormalities, such as high (or low) globulinemia, antiglobulin test and anti-nuclear antibody positive or myasthenia gravis, etc., recent studies have shown that in some patients with PRCA, T8 inhibits cell dysfunction May be related to the disease.
4. Iron granule anemia Anemia 16% of patients with secondary granulocytic anemia are secondary to neoplastic diseases, such as prostate cancer and myeloproliferative diseases, leukemia, myeloma, etc. How do tumors interfere with red blood cells? The mechanism of iron utilization is still unclear, and may be related to abnormal heme synthesis or abnormal erythroid hematopoietic progenitor cells in tumor patients.
5. Intramedullary tumor infiltration Malignant tumor Bone marrow metastasis can cause bone marrow anemia, common tumors prone to bone marrow metastasis are stomach, lung, prostate, breast, kidney cancer, bone marrow disease patients often with myelofibrosis, bone marrow puncture It is not easy to obtain ideal specimens, and bone marrow biopsy can be used for pathological examination.
6. Patients with megaloblastic anemia tumors occasionally have anemia of megaloblastic cells. Patients with folic acid deficiency are more likely to suffer from anorexia, insufficient intake, rapid tumor growth, excessive consumption of folic acid, digestive dysfunction, and decreased absorption. Because of the lack of vitamin B12, it is rare.
7. Iron deficiency of digestive tract tumors, uterine cancer often combined with bleeding, resulting in iron deficiency anemia.
8. Treatment-related anemia chemotherapy and radiotherapy lead to suppression of bone marrow function, which is quite common in clinical practice.
Prevention
Prevention of anemia caused by malignant tumor
There is no effective preventive measure for this disease. Early detection and early diagnosis are the key to the prevention and treatment of this disease.
Complication
Anemia-induced complications of anemia Complications microvascular hemolytic anemia
1. Shortening of red blood cell life: Most patients with anemia with tumors have a slight shortening of red blood cell life, which is related to the hyperfunction of mononuclear macrophage system. The red blood cells flow through the spleen. During the liver process, the cell membrane is continuously engulfed by mononuclear macrophages, causing red blood cells. Premature destruction.
2. Microvascular hemolytic anemia Advanced tumors may be associated with disseminated intravascular coagulation. Some gastric cancers and lung cancers may produce mucin, causing fibrin deposition in small blood vessels, resulting in a mechanism similar to DIC, allowing red blood cells to be in small blood vessels. damage.
Symptom
Symptoms of anemia caused by malignant tumors Common symptoms Myelosuppression, dizziness, palpitations, fatigue, activity, shortness of breath
The clinical manifestations vary with the type of tumor, the location of the tumor and the degree of metastatic spread. The anemia of the digestive tract is found earlier and the symptoms are severe. It is often associated with bleeding and nutrient absorption disorders, and even anemia is the first symptom of the tumor. On the contrary, the anemia of lung cancer is found late, the anemia is light, and the symptoms of anemia are often concealed by the symptoms of the tumor itself. Generally, the symptoms of anemia in the late stage of the tumor are more serious than the initial stage. Most of them are caused by chemotherapy or radiotherapy, bone marrow suppression, cancer bone marrow metastasis, and patients with low immunity and secondary infection. Caused by a combination of factors such as nutritional malabsorption.
Anyone with a clear cause is easy to diagnose, but some patients have anemia before the tumor is diagnosed. Even anemia is the first symptom of cancer patients, which is common in digestive tract tumors. Therefore, patients with unexplained anemia should consider the tumor in the differential diagnosis. For example, pure red blood cell aplastic anemia is common in thymoma, autoimmune hemolytic anemia can be seen in ovarian cancer and lymphoma, bone marrow smears need to be examined in detail when tumor bone marrow metastasis, and tumor cells aggregate and grow, such as bone marrow is "dry" Pumping, a bone marrow biopsy is needed to confirm the diagnosis.
Examine
Examination of anemia caused by malignant tumor
1. Peripheral blood is positive cells, positive pigmented anemia, reticulocytes increase, abnormal anemia can be seen in heteromorphic and fascinating red blood cells, such as microvascular anemia, the number of abnormal red blood cells increased significantly, patients with digestive tract tumors often combined with blood loss Its anemia manifests as small cells, hypochromic anemia, when the tumor metastasizes to the bone marrow, the surrounding blood may appear young red, the young cells, the anemia is moderate to severe, the white blood cells are normal or increased, because the tumor can stimulate the increase of neutrophils. As a result, the platelet count is normal or reduced.
2. The bone marrow should pay attention to the tumor cells. The cancer cells tend to have several aggregation or agglomeration tendency. The common features of the morphology are:
31 cells and nuclei are larger, and the staining is thicker.
2 polymorphism,
3 nuclear/cytoplasmic pulp ratio increases,
4 nucleoli large, varying in number, is heteromorphic, but primitive neuroblastoma, its cell morphology resembles the original or proto-lymphocytes, and there is no aggregation and agglomeration tendency, the cell membrane is easy to break, become naked nuclei, cytoplasm Containing mucus, glycogen reaction positive, tumor-induced iron granule anemia, iron staining of bone marrow erythrocytes increased, ring type iron granules >15%, often bone marrow cell necrosis.
3. The serum iron is reduced, the total iron binding capacity is normal or slightly decreased, and the iron saturation is reduced, which is consistent with the iron metabolism characteristics of patients with chronic disease anemia. However, if there is combined bleeding or obvious hemolysis, there are corresponding iron metabolism characteristics, and the red blood cell survival time is mostly shortened. .
Diagnosis
Diagnosis and diagnosis of anemia caused by malignant tumor
According to the condition, clinical manifestations, symptoms, signs, X-ray, CT, B-ultrasound, electrocardiogram, biochemical examination can make a diagnosis.
Gastrointestinal tumor anemia is found earlier, the symptoms are heavy, often associated with easy to cause bleeding and combined with nutritional malabsorption, and even anemia is the first symptom of the tumor and caused the doctor's attention. On the contrary, lung cancer anemia is found late, anemia is light, and anemia symptoms are often masked by the tumor itself. In general, the symptoms of advanced anemia in the late stage are more serious than the initial stage, and most of them are caused by a combination of factors such as bone marrow suppression, cancer bone marrow metastasis, secondary infection of patients with low immunity, and malabsorption of nutrients.
