Anemia in cancer patients.

Chronic anemia in cancer patients is caused by several pathophysiologic mechanisms. Reduced numbers of erythroid progenitor cells in the bone marrow and increased levels of inflammatory cytokines, which suppress erythropoiesis, result in a lower proliferative response of the erythron to erythropoietin stimulation. Erythropoietin production by the kidney in response to tissue hypoxia is often blunted; as a result, serum erythropoietin levels may be inappropriately low with regard to the degree of anemia. Red blood cell survival may be shortened; impaired iron utilization is manifested by enhanced retention of iron in the reticuloendothelial system. Chronic anemia also may be induced by cancer treatment, such as nephrotoxic chemotherapy.