Potential etiologies for cancer-associated anemia
| Causes of decreased Hb . | Production (decreased) . | Destruction (increased) . | Loss (overt, occult, or iatrogenic bleeding) . |
|---|---|---|---|
| Drugs/therapy | Myelosuppressive chemotherapy | Antibiotics (eg, β-lactams, dapsone) | Anticoagulation (eg, DOACs, LMWHs, warfarin) |
| Radiation therapy | Chemotherapy (eg, gemcitabine) | Antiplatelet agents (eg, clopidogrel, prasugrel, ticagrelor) | |
| Tyrosine kinase inhibitors (delayed maturation) | Immunotherapy (eg, nivolumab, pembrolizumab, ipilimumab) | Nonsteroidal anti-inflammatory drugs | |
| Immunotherapy (inflammation) | Intravenous immunoglobulin G | Over-the-counter supplements (eg, turmeric) | |
| Bugs (bacteria, virus, or fungi) | Cytomegalovirus | HIV | Helicobacter pylori |
| Parvovirus B19 (in SCT or immunocompromised patients) | |||
| Diseases, disorders, or other | Chronic kidney disease (decreased erythropoietin) | Microangiopathic hemolytic anemia (may be drug- or disease-related) | Gastrointestinal tumors |
| Clonal hematopoiesis of indeterminate potential | Frequent phlebotomy | ||
| Iron deficiency (AIDA or FIDA) | Autoimmune hemolytic anemia (eg, caused by autoimmune disorders or drug-induced) | Arteriovenous malformations | |
| Leukemia (acute or chronic) | Hemostatic disorders (inherited or acquired) | ||
| De novoor therapy-related myelodysplastic syndromes | Menses | ||
| Myeloproliferative neoplasms | Hemophagocytic lymphohistiocytosis | Surgery | |
| Solid tumors | Disseminated intravascular coagulation | ||
| Iron overload | |||
| B9 (folate) or B12 (cobalamin) deficiency |
| Causes of decreased Hb . | Production (decreased) . | Destruction (increased) . | Loss (overt, occult, or iatrogenic bleeding) . |
|---|---|---|---|
| Drugs/therapy | Myelosuppressive chemotherapy | Antibiotics (eg, β-lactams, dapsone) | Anticoagulation (eg, DOACs, LMWHs, warfarin) |
| Radiation therapy | Chemotherapy (eg, gemcitabine) | Antiplatelet agents (eg, clopidogrel, prasugrel, ticagrelor) | |
| Tyrosine kinase inhibitors (delayed maturation) | Immunotherapy (eg, nivolumab, pembrolizumab, ipilimumab) | Nonsteroidal anti-inflammatory drugs | |
| Immunotherapy (inflammation) | Intravenous immunoglobulin G | Over-the-counter supplements (eg, turmeric) | |
| Bugs (bacteria, virus, or fungi) | Cytomegalovirus | HIV | Helicobacter pylori |
| Parvovirus B19 (in SCT or immunocompromised patients) | |||
| Diseases, disorders, or other | Chronic kidney disease (decreased erythropoietin) | Microangiopathic hemolytic anemia (may be drug- or disease-related) | Gastrointestinal tumors |
| Clonal hematopoiesis of indeterminate potential | Frequent phlebotomy | ||
| Iron deficiency (AIDA or FIDA) | Autoimmune hemolytic anemia (eg, caused by autoimmune disorders or drug-induced) | Arteriovenous malformations | |
| Leukemia (acute or chronic) | Hemostatic disorders (inherited or acquired) | ||
| De novoor therapy-related myelodysplastic syndromes | Menses | ||
| Myeloproliferative neoplasms | Hemophagocytic lymphohistiocytosis | Surgery | |
| Solid tumors | Disseminated intravascular coagulation | ||
| Iron overload | |||
| B9 (folate) or B12 (cobalamin) deficiency |
This table represents the authors’ approach to defining etiologies of cancer-associated anemia. The main categories are production defects, destruction, and blood loss. Examples of each category are provided in the columns. This table does not represent a comprehensive list of all possible causes of cancer-associated anemia.
DOAC, direct oral anticoagulant; LMWH, low molecular weight heparin; SCT, stem cell transplantation.