ibraheem
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Q- 67 y-o man presents to the emergency room complaining of the onset of fatigue &shortness of breath over the past 2 days.His history is significant for stage 3 colorectal carcinoma that was diagnosed 15 mo ago &was initially treated by hemicolectomy&adjuvant 5FU/leucovorin with good result . However a CT scan performed 3 wk ago showed the presence of several small lesions in the liver.Fine needle biopsy reveald adenocarcinoma consistent with his primary cancer and he was restarted on chemotherapy 2 wk ago. On examination he is pale & in obvious distress.Bl. P.96/62 & Ht. R. 112/min .He has a well- healed midline abdominal scar & scattered petechiae over the right abdomen ,stool is positive for occult blood.Significant lab.values are as follows WBC 1.8X 1000/UL, Hgb of 7.1 g/dL &platelet count of 26,000/UL, Which of the following is most likely the primary cause of his anemia?
* Metastatic tumor infilteration of the bone marrow.
*Coagulopathy secondary to involvement of the liver .
*Decreased red cell production secondary to chemotherapy.
*Bleeding due to thrombocytopenia (secondary to chemotherapy ).
*Anemia of chronic disease.
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| ARJ
Forum Guru
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Decreased red cell production secondary to chemotherapy
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| phuluong2k
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I agree with you
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| kabu
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Me too
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| ibraheem
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Bleeding due to thrombocytopenia (secondary to chemotherapy).
Anemia, especially in older patients often has multiple causes. While decreased red cell production as with bone marrow infilteration or anemia of chronic disease & higher rates of red cell destruction must be considered, the most common cause of severe anemia is acute blood loss. One of the most feared complications of chemotherapy is bone marrow supression, which can lead to neutropenia & thrombocytopenia several days after treatment, increasing the risk of infection & bleeding , While red cell precursors in the bone marrow are also affected by chemotherapy , red blood cells survive in the circulation for 120 days. Therefore, anemia is usually not noticable until a couple of months following the beginning of therapy. Leukocytes& plateletes on the other hand, normally last only a few days. Therefore, over all levels may drop rapidly after chemotherapy & must be monitored closely. The most common areas of metastasis for colorectal cancer are the liver & lungs. a large portion of the liver would have to be involved before coagulopathy would be evident, and it is more likely that other signs such as gross hepatomegaly & ascites would be present first. Metastsis to bone does occur in colorectal cancer but is less common & is usually accompaained by pain at the site of infilteration. Any effect on blood cell production would likely be gradual. Gradual onset would also be expected with anemia of chronic disease. While this is a potential complication of most neoplasms the patient's body usually has a chance to adjust to the lower oxygen levels&the hematocrit rarely falls below 25%.
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| DrS
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Nice question Ibrahim 
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