Prognostic Implications Of Anemia Research Articles

Prognostic Role of Anemia in COVID-19 Patients: A Meta-Analysis.

Introduction. The prevalence and prognostic implications of anemia in patients infected by the SARS-CoV-2 remains unclear. We performed a systematic review and meta-analysis to assess the prevalence and mortality risk in COVID-19 patients with anemia. Methods. Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed in abstracting data and assessing validity. We searched MEDLINE and Scopus to locate all the articles published up to 1 September 2021, reporting data on the adjusted OR (aOR) for mortality among COVID-19 patients with anemia. The pooled prevalence of anemia among COVID-19 patients was calculated using a random effects model and presenting the related 95% confidence interval (CI), while the mortality risk was estimated using the Mantel-Haenszel random effects models with odds ratio (aOR) and related 95% CI. Statistical heterogeneity was measured using the Higgins I2 statistic. Results. Five studies, enrolling 9.623 COVID-19 patients [3.707 males (38.5%)], met the inclusion criteria and were included in the final analysis. The pooled prevalence of anemia was 25.6% of cases (95% CI: 8.3–56.5%), with high heterogeneity (I2 = 98.9%). Meta-regression showed that the anemia prevalence was influenced by a direct correlation with age (p = 0.007) and chronic kidney disease (p = 0.004) as moderating variables. Conversely, an inverse relationship was observed with male gender (p < 0.0001). Anemia was significantly associated with higher risk of short-term mortality (aOR: 1.69, 95% CI: 1.28–2.24, p < 0.001), with low heterogeneity (I2 = 0%). Conclusions. Anemia represents a major comorbidity in about 25% of COVID-19 patients and it is associated with about 70% higher risk of short-term mortality.

Prognostic implications of Anemia in patients with acute heart failure in emergency departments. ANEM-AHF Study.

The presence of anaemia leads to a worse prognosis in patients with heart failure (HF). There are few data on the impact of anaemia on mortality in patients with acute heart failure (AHF), and the studies available are mainly retrospective, and include hospitalised patients. Evaluate the role of anaemia on 30-day and 1-year mortality in patients with AHF attended in hospital emergency departments (HEDs). We performed a multicentre, observational study of prospective cohorts of patients with AHF. The study variables were: Anaemia (haemoglobin <12g/dL in women and <13g/dL in men), mortality at 30days and at 1year, risk factors, comorbidity, functional impairment, basal functional grade for dyspnoea, chronic and acute treatment, clinical and analytical data of the episode, and patient destination. Bivariate analysis and survival analyses using Cox regression. A total of 13454 patients were included, 7662 (56.9%) of whom had anaemia. Those with anaemia were older, had more comorbidity, a worse functional status and New York Heart Association class, greater renal function impairment, and more hyponatraemia. The mortality was higher in patients with anaemia at 30days and 1year: 7.5% vs 10.7% (P<.001) and 21.2% vs 31.4% (P<.001), respectively. The crude and adjusted hazard ratios of anaemia for 30-day mortality were: 1.46 (confidence interval [CI] 95% 1.30-1.64); P<.001 and 1.20 (CI 95% 1.05-1.38); P=.009, respectively, and 1.57 (CI 95% 1.47-1.68) and 1.30 (CI 95% 1.20-1.40) for mortality at 1year. The weight of anaemia on mortality was different in each follow-up period. Anaemia is an independent predictor of mortality at 30days and 1year in patients with AHF attended in HEDs. It is important to study the aetiology of AHF since adequate treatment would reduce mortality.

Anemia and postoperative outcomes after open and endovascular repair of intact abdominal aortic aneurysms

ObjectiveAnemia is associated with increased cardiac adverse events during the early postoperative period because of high physiologic stress and increased cardiac demand. The aim of this study was to assess the surgical outcomes and prognostic implications of anemia in patients undergoing repair of intact abdominal aortic aneurysms (AAAs). MethodsA retrospective analysis of all patients who underwent open aortic repair (OAR) or endovascular aneurysm repair (EVAR) in the Vascular Quality Initiative database (2008-2017) was performed. Patients with preoperative polycythemia, patients with ruptured aneurysms, and patients transfused with >4 units of packed red blood cells were excluded. Hemoglobin levels were categorized into three groups: moderate-severe anemia (<10 g/dL), mild anemia (10-12 g/dL in women and 10-13 g/dL in men), and no anemia (>12 g/dL in women and >13 g/dL in men). Multivariate logistic models and coarsened exact matching were used to analyze the association between anemia and 30-day mortality and between anemia and major in-hospital complications after OAR and EVAR. ResultsA total of 34,397 patients were identified undergoing AAA repair. Of those, 28.5% had mild anemia and 4.3% had moderate-severe anemia. In both OAR (n = 6112) and EVAR (n = 28,285), patients with moderate-severe anemia had significantly higher rates of in-hospital adverse events, such as in-hospital mortality, myocardial infarction, renal and respiratory complications, and reoperation, compared with patients with mild or no anemia. They also had higher rates of 30-day mortality. After multivariate analysis and 1:1 coarsened exact matching, no association was found between anemia and 30-day mortality and other in-hospital outcomes in patients undergoing OAR. On the other hand, in EVAR, moderate-severe anemia was associated with 2.7 times the odds of 30-day mortality (odds ratio [OR], 2.65; 95% confidence interval [CI], 1.69-4.18), 2.5 times the odds of renal complications (OR, 2.47; 95% CI, 1.78-3.43; P < .05), and twice the risk of acute congestive heart failure (OR, 1.96; 95% CI, 1.18-3.25) and respiratory complications (OR, 2.01; 95% CI, 1.26-3.19). Mild anemia was also associated with increased odds of 30-day mortality and renal and respiratory complications in patients undergoing EVAR. Interestingly, preoperative blood transfusion in mildly anemic patients undergoing EVAR was associated with double the odds of in-hospital major adverse cardiac events (stroke, death, and myocardial infarction; OR, 2.1; 95% CI, 1.38-3.11; P < .001). ConclusionsPreoperative anemia is associated with higher odds of 30-day mortality and in-hospital adverse outcomes after EVAR but not after OAR. These findings highlight the need to incorporate anemia into the preoperative risk assessment of patients undergoing EVAR. Future studies are needed to assess the efficacy of medical therapies in improving postoperative outcomes in anemic patients undergoing AAA repair.

Impact of anemia as risk factor for major bleeding and mortality in patients with acute coronary syndrome

BackgroundAnemia is frequent in acute coronary syndrome (ACS) patients and is associated with worse clinical outcomes. We aimed to investigate the therapeutic strategies, the use of novel P2Y12 inhibitors, and the prognostic implication of anemia in a “real world” cohort of ACS patients. MethodsThis is an observational and prospective registry including 1717 ACS patients from three tertiary hospitals. During hospitalization we recorded the clinical management and the antiplatelet therapy at discharge. Patients were divided into 2 groups according to the baseline hemoglobin level, i.e. anemic (hemoglobin < 13 g/dL in men and <12 g/dL in women) and non-anemic patients. Bleeding events, mortality and major adverse cardiovascular events (MACEs) were recorded during 1-year of follow-up. ResultsAnemia was present in 445 (25.9%) patients. Cardiac catheterization (83.8% vs. 94.5%, p < .001), and revascularization by percutaneous coronary intervention (53.5% vs. 70.5%, p < .001) were less frequent in these patients. Excluding anticoagulated patients, novel P2Y12 inhibitors were less prescribed in anemic patients (OR 2.80 [95% CI 2.13–3.67], p < .001). Anemia was independently associated with major bleeding (HR 2.26 [95% CI 1.07–4.78], p = .033) and all-cause mortality (HR 1.62 [95% CI 1.03–2.56], p = .038), but not with MACE. At 1-year of follow-up, the risk of mortality in anemic patients taking clopidogrel was higher (HR 2.38 [95% CI 1.01–5.67]; p = .049). ConclusionsIn this registry involving ACS patients, anemia had influence on clinical management and antiplatelet therapy. Patients suffering from anemia had higher risk for major bleeding and mortality. In particular, anemic patients treated with clopidogrel had even more mortality events.

The Impact of Allogeneic Hematopoietic Cell Transplantation (HCT) and Treatment with Ruxolitinib on Survival in Patients with Myelofibrosis

Allogeneic HCT is curative in myelofibrosis (MF) with a survival (OS) advantage compared to non-JAK-inhibitor treatments in patients (pts) with Int-2/high-risk DIPSS (Kroeger et al, Blood 2015). On the other hand, data demonstrate a OS benefit of the JAK1/JAK2 inhibitor ruxolitinib (RUX) in intermediate (Int)-2/high-risk IPSS (Cervantes et al, Blood 2013; Verstovsek et al, Haematologica 2015). Yet, comparative data to the impact of RUX and HCT on OS are lacking. This was pursued retrospectively at the University of Leipzig in light of clinical-, cytogenetic-, phenotype-driver-, and somatic mutations-based prognostic variables.Patient and Methods: RUX became available in November, 2009. MF pts (n=137; median age 58y) seen afterwards were included with the exception of MPL + pts (small number). Characteristics are shown in table 1. RUX was given for spleenomegaly and/or constitutional symptoms [n=76 (55%)]. Irrespective of RUX, a donor search was initiated in int-2 and high-risk IPSS pts < 70 y and HCT performed if a suitable donor identified. Based on this biologic randomization, 50 (37%) received HCT, 58 (42%) continued with RUX (median exposure 19 months), and 29 (21%) pts had other options. The RUX- and HCT-groups were balanced in terms of IPSS, platelets, cytogenetic-, and epigenetic molecular-risks. Treatment was initiated within the first year (median 10 months), thus probability of OS 5 years after diagnosis was calculated (SPSS20 software). Cytogenetic-risk was conducted according to Caramazza et al. Leukemia 2011. Somatic mutations detected by NGS were used to calculate molecular-risk (Vannucchi et al. Leukemia 2013).Results: Median OS time was 6.8 y. The RUX-group was older (median age 64 y) with profound spleenomegaly and a higher JAK2 V617F allele burden compared to the HCT group (median age 55 y) (p<0.0005). The 56% OS at 5 years in the RUX group was comparable to that after HCT (60%; p=0.5). In the transplant setting, prior RUX-treatment (n=21; OS 65%) had no negative impact compared to up-front HCT (n=29; OS 55%) (p=0.9). Whilst IPSS low-/int-1-risk retained its survival impact (p=0.04), OS at 5 years was comparable for int-2 and high-risk. OS in the HCT and RUX groups for int-2 was 59% and 62% respectively (p=0.4) and for high-risk IPSS 54% and 50% respectively (p=0.2). Advanced age was associated with an inferior OS (p=0.002) and correlated with higher IPSS, transfusion-dependency and thrombocytopenia. In the HCT group, OS in pts <50 y was 91% vs. 49% in pts >50 y (p=0.001). In the RUX group, age <60 and not <50 y was OS-relevant [79% in pts <60y vs. 43% in those >60 y (p=0.02)]. No prognostic implication of anemia, WBC, peripheral blasts, and constitutional symptoms could be detected with both treatments. OS in JAK2 + pts was similar to CALR + pts in both therapy cohorts (p=0.3). Triple negativity retained its detrimental influence (p<0.0001) even after HCT, with frequent AML-typical mutations (transcription and/or signaling genes) and a leukemic transformation (LT) rate of 35%. Although spliceosome mutations were associated with anemia (p=0.004)/transfusion-dependency (p=0.006) and mutations in chromatin modifiers (ASXL1, EZH2) with splenomegaly(p=0.02),high-molecular epigenetic risk had no impact on OS or LT in the treatment groups. Unfavourable cytogenetics were associated with LT (p=0.04) but not OS in the two groups. Of the 24 pts with a LT, 15 (62%) received no RUX and no HCT.Conclusions: Our data imply that, besides allogeneic HCT, a prolonged JAK1/JAK2 inhibition could, at least partly, attenuate most of the prognostic detrimental parameters. Pre-treatment with ruxolitinib prior to HCT does not seem to have a negative impact on survival. It is the first time where outcome with a non-transplant procedure is shown to be comparable to that after HCT in MF, even in high-risk disease. This needs to be verified in prospective randomized trials to define the role of allogeneic HCT in the era of JAK1/JAK2 inhibition.Table 1Patients characteristics ( n = 137 )VariableImpact on OSImpact on LTMedian age (years)580.0020.6JAK2+/CALR+/Double negative (%)63 / 20 / 17<0.00050.04Median number of MF-related mutations (range)1 (0-5)0.40.07High-molecular risk profile (%)(ASXL1, EZH2, SRSF2, IDH1/2)33.60.80.7Mutations in transcription/signaling genes (%)280.30.008Unfavorable cytogenetics (%)300.10.04IPSS (Int-2 / high-risk) (%)34 / 410.040.2 DisclosuresRoskos:Novartis: Honoraria. Al-Ali:Celgene: Honoraria, Research Funding; Novartis: Consultancy, Honoraria, Research Funding.

Prognostic implications of anemia with or without chronic kidney disease in patients undergoing elective percutaneous coronary intervention

BackgroundLittle is known about the prognostic implications of anemia in patients undergoing elective percutaneous coronary intervention (PCI), especially when they have coexisting chronic kidney disease (CKD). MethodsWe identified 7299 patients who underwent elective PCI from the CREDO-Kyoto registry cohort-2. The primary outcome was 3-year major adverse cardiac events (MACE); composite of all cause death, heart failure hospitalization, and myocardial infarction. ResultsIn total, 1466 patients (20.0%) had mild anemia (hemoglobin=11.0–11.9g/dL for women and 11.0–12.9g/dL for men), and 740 patients (10.1%) had moderate-to-severe anemia (hemoglobin<11.0g/dL both for women and for men). Compared to the no-anemia group, cumulative incidence of MACE was significantly higher in the mild and moderate-to-severe anemia groups (7.9%, 20.1%, and 34.2%, respectively). The adjusted hazard ratios of mild and moderate-to-severe anemia versus no-anemia for MACE were 1.77 (95% confidence interval: 1.47–2.15) and 2.53 (95% confidence interval: 2.03–3.14), respectively. In a subgroup analysis, significantly higher risk for MACE was consistently observed with mild and moderate-to-severe anemia both in patients with and without CKD. The risk for MACE showed an accretive increment with exacerbation in either the renal function or anemia (interaction p<0.001). ConclusionsEven mild anemia was associated with significantly worse 3-year clinical outcomes in patients who underwent elective PCI. Coexisting CKD additively increased the risk for MACE in these patients.

AS-219 Prognostic Implication of Anemia on Clinical Outcomes After Percutaneous Coronary Intervention with Drug-Eluting Stent

AS-219 Prognostic Implication of Anemia on Clinical Outcomes After Percutaneous Coronary Intervention with Drug-Eluting Stent

Prognostic implications of anemia in older adults

Anemia is highly prevalent in geriatric practice. In this perspective article, Dr. Patel and Guralnik conclude that this condition is associated with adverse health and functional outcomes in older persons. See related article on page 22.

High Prevalence of Elderly Anemia Is Seen in a Large Inner City Outpatient Population and Is Predictive of Decreased Overall Survival across All Ethnic Groups

Recent work has hinted at the prognostic importance of anemia in the elderly and has tried to identify causes. In an effort to further explore this important clinical problem, we decided to determine the prevalence, etiology and prognostic implications of anemia in a large inner city cohort of elderly outpatients. A total of 40,417 individuals ≥65 years of age seen at Montefiore medical system outpatient clinics from January 1st 1997 to May 1st 2008 who underwent a complete blood count within 3 months of the visit were included in the cohort. Using gender specific WHO criteria, we determined 35.3% of men (out of 15,629) and 28.8% of women (out of 24,788) were anemic at the time of their first clinic visit. A follow up of their blood counts showed that ultimately 70.7% of men and 65.4% of women subsequently developed anemia, thus demonstrating a very high incidence in this population. Among anemic patients, 14.2% had microcytosis and 11.2% had macrocytosis. Of all microcytic anemic patients, 57.3% had both ferritin and iron saturation performed and 19.1% of those tested met criteria for iron deficiency anemia. Of all macrocytic anemic patients, 51.7% had folate and 53.2% had B12 levels checked. However, of those tested only 0.6% and 6.8% had folate and B12 deficiency respectively. This percentage of abnormal findings was similar to non-anemics (0.3% and 5.5% respectively). Evaluation for further etiologies of anemia revealed that 10.0% had thrombocytopenia, 13.5% had leukopenia, and 2.0% had neutropenia, raising the possibility of bone marrow failure and myelodysplastic syndrome (MDS) in these patients. Of the 3,471 anemic patients with other cytopenias, only 6.1% had a bone marrow examination (n=213). Subsequent diagnosis of MDS was made in a minority of these patients. A search for other chronic diseases among the anemic group revealed an elevated creatinine in 11.2%, a subsequently elevated TSH in 17.5%, transaminitis in 28.0% and hypoalbuminemia in 21.9%. Of anemic patients who had an ESR and an ANA assay performed, 69.7% and 23.1% had abnormal results respectively. Overall, a possible etiology based on the above laboratory findings was only identified in 61.9% of anemic patients. Of the small number of anemic patients who had every one of the above tests performed (n=662), 12.1% did not have any abnormal results.To determine the functional importance of these findings, Kaplan-Meier curves and multivariate Cox regression analyses were performed to compare survival and mortality in this cohort. Anemic patients had reduced overall survival regardless of ethnicity (Figure 1). Interestingly, among the elderly, minorities appeared to have better survival than Caucasian whites regardless of anemia status. This is likely secondary to selection bias in this age group as minorities have higher mortality rates below age 65. Adjusting for age and gender, the overall hazard ratio (HR) comparing anemic patients with nonanemic patients was 2.15 (p<0.001). Repeating for each ethnicity subgroup resulted in adjusted HRs of 1.93 (p<0.001) in whites, 2.00 (p<0.001) in blacks, and 2.44 (p<0.001) in Hispanics. Multivariate analyses of various lab parameters demonstrated that an elevated RDW (>16.6%) was the strongest predictor of decreased survival in anemic patients with an age/gender/Hb-adjusted HR of 1.73 (p<0.001). (Figure 2) Thrombocytopenia (HR= 1.37, p<0.001), leukocytosis (HR=1.37, p<0.001), neutropenia (HR=1.23, p=0.032) and macrocytosis (HR=1.24, p<0.001) were additional poor prognostic factors, raising the possibility of MDS as an adverse diagnostic subcategory of anemia in the elderly.In conclusion, we determined that anemia is very common among the elderly in the outpatient setting, and the majority of non-anemic patients ≥65 years of age ultimately develop this condition. Folate/B12 screening has minimal diagnostic utility in anemic patients. Anemia is associated with decreased survival in all racial groups, with larger effects in African Americans and Hispanics. An elevated RDW and the presence of other cytopenias are highly predictive of mortality in anemic patients even after controlling for age, gender and hemoglobin. [Display omitted] [Display omitted]

Letter Regarding Article by McKechnie et al, “Prognostic Implication of Anemia on In-Hospital Outcomes After Percutaneous Coronary Intervention”

To the Editor: With great interest we have read the article by McKechnie and colleagues1 about the higher rates of in-hospital mortality in anemic patients undergoing percutaneous coronary intervention (PCI). In brief, they observed in their analysis of 45 165 patients in the quartile with the lowest hemoglobin concentrations (men: 6.6 to 10.1 g/dL; women: 5.4 to 9.5 g/dL) an in-hospital mortality rate for men of 5.0% compared with 2.8%, 1.9%, and 1.9% in the other quartiles, respectively (women: 3.2% versus 2.6%, 2.2%, and 1.8%, respectively). Of note, a relevant number of PCI patients had acute (16.3%) or recent myocardial infarctions (33.5%), and 2.3% had cardiogenic shock. These results are complementary to previous findings of our group, in which we assessed the short- and long-term outcomes of 689 men who underwent elective PCI.2 In contrast, we found similar in-hospital outcomes in the lowest hemoglobin quintile (8.5 to 12.9 g/dL) as compared with the other quintiles. This might be the result of …

Prognostic implication of anemia on in-hospital outcomes after percutaneous coronary intervention

Prognostic implication of anemia on in-hospital outcomes after percutaneous coronary intervention

Prognostic implication of anemia on in-hospital outcomes after percutaneous coronary intervention.

Although prior studies have shown a relationship between anemia and in-hospital mortality after coronary artery bypass grafting and acute myocardial infarction (MI), the prognostic implication of anemia in patients undergoing percutaneous coronary intervention (PCI) is unknown. Therefore, we evaluated the relationship between anemia and outcomes of PCI. Clinical and outcome data on 48,851 consecutive PCIs were prospectively collected. Patients were classified as anemic using the World Health Organization definition (<12.0 g/dL in women and <13.0 g/dL in men). A total of 6471 men (21.7%) and 4659 women (30.4%) were anemic. Anemic men and women were older and had a higher percentage of comorbidities compared with their nonanemic cohorts (P<0.0001 for all comparisons). When compared with nonanemic patients, anemic patients had higher in-hospital mortality (3.0% versus 0.8% in men; 2.4% versus 1.5% in women; P< or =0.0001) and postprocedural MI (2.0% versus 1.6% in men; 2.4% versus 1.6% in women; P< or =0.02) and a higher combined major cardiovascular events end point, including death, MI, and cerebrovascular event (5.0% versus 2.6% in men; 5.1% versus 3.5% in women; P<0.0001). After adjustment for comorbidities, anemia was associated with a higher risk of in-hospital mortality (odds ratio [OR], 2.29; 95% CI, 1.79 to 2.92; P<0.0001) and MI (OR, 1.34; 95% CI, 1.05 to 1.72; P=0.02) and major cardiovascular events (OR, 1.2; 95% CI, 1.05 to 1.34). Significant gender interactions were observed for death in men and for MI in women. Preprocedural anemia is associated with increased adverse in-hospital outcomes after PCI. Whether optimization of hemoglobin before PCI is of clinical benefit will need to be determined in a randomized clinical trial.

Prevalence and prognostic implication of anemia in decompensated chronic heart failure setting

Background: Several studies have demonstrated an association between anemia and prognosis in chronic heart failure (CHF). The role of anemia as an independent predictor of adverse outcomes needs to be confirmed in order to determine what treatment strategies, if any, are appropriate to treat anemia in this population. We examined the incidence, associated variable and short- and long-term prognosis in patients with decompensated heart failure and anemia. Methods: Between december/97 and March/00, three hundred and thirty patients were admitted because of decompensated HF. Anemia was defined by the presence of hematocrit less than 37% in women and less than 39% in men. Results: Anemia was diagnosed in 91 patients (29.1%), 24% in women vs. 32% in men (p = ns). Mean age in those with anemia (Group 1) was 62.9±14 compared with 65.5±15 in patients without anemia (Group 2)(p = ns). The following characteristics were different between Group 1 and Group 2: hypertension 33% vs 21% (p = 0.034) and chronic renal insufficiency (56 vs 27%, p = 0.002). In patients with and without anemia, NYHA functional class (2.24 vs. 2.33, p = ns) and ischemic etiology were similar (32% vs. 27%p = ns), and the prevalence of sinus rhythm was higher in subjects with anemia (34% vs 22%, p = 0.028). In groups 1 and 2, mean ejection fraction was 42.4±18 and 37.6±17% (p = 0.031), creatinine level was 1.8±1.6 vs. 1.3±0.4 mg/dL (p<0.001), and serum sodium level was 138±4.3 vs. 139.8±5.4 mEq/L (p = 0.03). Logistic regression analysis identified peripheral hypoperfusion (p<0.001,OR = 3.85) and natremia (p = 0.01,OR = 0.93) as independently associated with anemia. During hospitalization, the incidence of refractory heart failure was 8.8% in group 1 and 3.2% in group 2 (p = 0.043), and mortality rate was 2.9% vs 1% (p = ns), respectively. Twenty-four months cumulative survival was 40% in group 1 and 80% in group 2 (log rank test p = 0.041). Conclusion: Anemia was a frequent co-morbidity that afflicted one third of patients with decompensated heart failure, and it was related with other markers of disease severity. Short- as well as long-term prognosis were poor in subjects with anemia. Beside ongoing clinical trials researching the role of therapies for anemia in the treatment of patients with chronic heart failure, the effect of that therapies in decompensation setting should be evaluated

Anemia in cancer.

In summary, anemia developing in a patient with cancer can be due to several different factors. A relative failure of erythropoiesis, in conjunction with a modestly shortened erythrocyte survival, is the most likely explanation for the anemia and can occur in patients with or without bone marrow invasion. Several theories have been proposed to explain the mechanism of limited red cell production in cancer. Internal iron starvation and cancer toxic factors have been widely implicated. Immunoglobulin inhibitors of erythropoiesis occur in the rare entity, pure red cell aplasia, which is sometimes associated with thymomas. Autoimmune hemolytic anemia and microangiopathic hemolytic anemia can also occur in patients with solid cancers, pointing out the need for a complete evaluation of anemia in any patient with recent-onset anemia. Successful treatment and prognostic implications of anemia in cancer is dependent on proper diagnosis.