A study of the prevalence and type of anemia in lymphoid malignancies

Abstract

e19556 Background: Anemia is a common and serious problem in patients with lymphoid malignancy. Hence there was need to analyze the prevalence of anemia in our patient population and evaluate its cause for optimal management. Methods: Newly diagnosed patients of lymphoid malignancy- non Hodgkins lymphoma (NHL), Hodgkins lymphoma (HL), and chronic lymphocytic leukemia (CLL) aged more than 15 years without renal failure and who had not received blood transfusion, iron, folic acid or vitamin B complex in the last 2 weeks were analyzed. 316 patients were screened for the prevalence of anemia. Of the anemic patients (hemoglobin <11gm/dl), 46 were studied for the type of anemia. These patients underwent the following investigations -complete hemogram with RBC indices, hematocrit, reticulocyte count, peripheral blood smear (PBS) examination, direct Coombs test (DCT), bone marrow (BM) aspiration and biopsy, S. iron (SI), S. ferritin (SF), total iron binding capacity (TIBC), percentage saturation (psat), S. Vitamin B12 and Folic acid levels. Anemia was categorized as due to either autoimmune hemolytic anemia (AIHA)-DCT positive with evidence of hemolysis on PBS, B12 and folate deficiency (<200 pgm/ml and < 4ngm/ml respectively), iron deficiency anemia (IDA)- psat <20% and SF315μgm/dl, anemia of chronic disease (ACD)-psat200μgm/L, a combination of IDA and ACD -psat <20%, SF -30–200 with TIBC ≤315 μgm/dl. Results: The prevalence of anemia in patients with lymphoid malignancy was 42.41% (134 /316, 95% CI-36.96% -47.85%). It was multifactorial in 39.13% (18/46) patients. ACD was the most common cause of anemia present in 71.74% (33/46) patients. This was followed by nutritional anemia (iron,B12 and folate deficiency) in 47.83% (22/46) and AIHA in 10.87% (5/46) of patients. Conclusions: Although anemia of chronic disease is the most common cause of anemia in patients with lymphoid malignancy, it is multifactorial in a large number of patients and hence it is important to rule out other causes of anemia like nutritional and AIHA in these patients. No significant financial relationships to disclose.