Anemia in malignant neoplastic disease

The problem of anemia in cancer is a highly significant one, as measured in terms of patient discomfort and the difficulties of clinical management. Its occurrence is as high as 95 per cent in some forms of cancer arising from the lymph nodes and marrow. The development of an understanding of this problem has been traced during the past 60 years, commencing with the realization by early morphologists of other factors being responsible for anemia besides simple tumor replacement of the blood-forming organs. The various techniques useful in the study of this problem have been described briefly, and the value of recent radioisotopic and immunologie data discussed and emphasized. In using the high precision analyses provided by radioisotopes and immunologic study, the clinician must never lose sight of the most important cause of anemia in the patient with cancer, namely, blood loss, nor of the other factors which may not be obvious but must be considered and can be demonstrated with routine laboratory methods. When these causes have been quantified or eliminated, then the more subtle factors of decreased erythropoiesis and increased hemolysis may be measured and evaluated. It is only by such a total survey of the patient, and by continued research into the mechanisms of the anemia of cancer that a clear understanding of this problem will be achieved.