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Blood Res (2024) 59:26
Published online August 7, 2024
https://doi.org/10.1007/s44313-024-00030-w
© The Korean Society of Hematology
Functional iron deficiency anemia in patients with cancer
Correspondence to : *Correspondence:
Ik‑Chan Song
petrosong@cnu.ac.kr
© The Author(s) 2024. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.
Anemia is frequently observed in patients with cancer owing to anticancer chemotherapy, radiation therapy, and inflammatory responses. This often leads to functional iron deficiency, characterized by adequate iron stores but impaired use of iron for red blood cell production. This condition, termed functional iron deficiency anemia (IDA), is identified by a ferritin level of 30–500 μg/dL and a transferrin saturation < 50%. Functional iron deficiency often develops with the prolonged use of erythropoiesis-stimulating agents, leading to a diminished response to anemia treatment. Although oral iron supplementation is common, intravenous iron is more effective and recommended in such cases. Recent studies have shown that ferric carboxymaltose (FCM) is effective in treating functional IDA in patients with cancer. However, because of its potential to induce asymptomatic severe phosphate deficiency, it is important to closely monitor phosphate levels in patients receiving FCM.
Keywords Functional iron deficincy, Anemia, Cancer, Hepcidin
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REVIEW
Blood Res 2024; 59():
Published online August 7, 2024 https://doi.org/10.1007/s44313-024-00030-w
Copyright © The Korean Society of Hematology.
Functional iron deficiency anemia in patients with cancer
Jeong Suk Koh1 and Ik‑Chan Song1*
1 Division of Hemato‑Oncology, Department of Internal Medicine, Chungnam National University Hospital, 282 Munwha‑Ro, Jung‑Gu, Daejeon 35015, South Korea
Correspondence to:*Correspondence:
Ik‑Chan Song
petrosong@cnu.ac.kr
© The Author(s) 2024. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.
Abstract
Anemia is frequently observed in patients with cancer owing to anticancer chemotherapy, radiation therapy, and inflammatory responses. This often leads to functional iron deficiency, characterized by adequate iron stores but impaired use of iron for red blood cell production. This condition, termed functional iron deficiency anemia (IDA), is identified by a ferritin level of 30–500 μg/dL and a transferrin saturation < 50%. Functional iron deficiency often develops with the prolonged use of erythropoiesis-stimulating agents, leading to a diminished response to anemia treatment. Although oral iron supplementation is common, intravenous iron is more effective and recommended in such cases. Recent studies have shown that ferric carboxymaltose (FCM) is effective in treating functional IDA in patients with cancer. However, because of its potential to induce asymptomatic severe phosphate deficiency, it is important to closely monitor phosphate levels in patients receiving FCM.
Keywords: Functional iron deficincy, Anemia, Cancer, Hepcidin
Fig 1.
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Table 1 . Differential diagnosis of IDA, anemia of inflammation and functional IDA.
Tests Iron deficiency anemia Anemia of Inflammation Functional IDA Blood Smear Microcytic and hypochromic RBCs Normal, Microcytic and hypochromic RBCs Normal Serum Iron (μg/dL) < 30 < 50 Variable TIBC > 360 < 300 Variable Transferrin Saturation < 10% 10–20% < 50% Ferritin (μg/dL) < 15 30–200 30–500 TIBC Total Iron binding capacity.
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Table 2 . Cause of iron deficiency anemia.
Increased iron loss Inadequate iron absorption Increased iron demand Gastrointestinal blood loss: epistaxis, varices, gastritis, ulcer, tumor, Meckel’s diverticulum, vascular malformation, inflammatory bowel disease, diverticulosis, hemorrhoids.
Genitourinary blood loss: menorrhagia, cancer, chronic infection.
Others: trauma, excessive phlebotomy, cupping.
Gastrectomy (partial or total).
Bariatric sleeve gastrectomy.
Inflammatory bowel disease.
Helicobacter pylori infection Antacid, H2- blocker, proton-pump inhibitor therapy or high gastric pH.
Excessive dietary bran, tannin, phytates, or starch.
Rapid growth (adolescence).
Pregnancy.
Erythropoiesis stimulating agents use.
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