ABSTRACT
With infectious and inflammatory syndromes, malignant diseases comprise one of the major categories of clinical disorders traditionally associated with the anemia of chronic disease. In the series of anemic patients reported by Cash and Sears from
an urban general hospital, 19% of anemia of chronic disease (ACD) patients had a nonhematologic malignancy (1). (Patients with hematologic diagnoses were specifically excluded from that series.)
It is difficult to define the frequency of ACD in specific malignant syndromes. As will be discussed in more detail below, the frequency of ACD in various solid tumor syndromes reflects underlying mechanisms contributing to anemia specific to those diseases; in addition, ACD is typically more common in advanced disease than it is in localized cancer. For example, the vast majority of anemias in colon cancer (particularly at early stages) will reflect blood loss with or without consequent iron deficiency. In solid tumors without associated blood loss, ACD is likely to be the dominant anemia syndrome observed early in the course of disease. In the series by Cash and Sears referred to above, 23% of anemic patients had a solid tumor. Of these patients, 44% met the study’s criteria for ACD (hypoferremia with a midrange or higher ferritin) (1). In a series of solid tumor patients referred for radiation therapy (2), approximately half were anemic, and approximately three-quarters of the patients whose anemia was investigated further were felt to have ACD.
