Improving the Laboratory Diagnosis and Differential Diagnosis of Various Forms of Anemia in Oncologic Diseases

Abstract

Objective: to systematize the methods of laboratory diagnosis of the forms of anemia that occur in oncologic diseases and to improve the differential diagnostic algorithm. Materials and methods: an analytical review was conducted of data presented in international clinical guidelines (ESMO, ASCO/ASH), systematic reviews, and laboratory diagnostic recommendations; the diagnostic value of laboratory parameters (ferritin, transferrin saturation, soluble transferrin receptor, reticulocyte hemoglobin, C-reactive protein, hepcidin, lactate dehydrogenase, haptoglobin, vitamin B12, folic acid, and others) was comparatively assessed. Results: in oncology patients, anemia is often of mixed origin and may present simultaneously as anemia of inflammation, absolute and functional iron deficiency, chemotherapy-induced myelosuppression, blood loss, bone marrow infiltration, and hemolysis. The traditional ferritin cut-off (<30 ng/mL) loses sensitivity under inflammatory conditions; a combination of ferritin, transferrin saturation, the sTfR/log-ferritin index, and reticulocyte hemoglobin allows the different forms to be distinguished more reliably. A three-stage algorithm (screening – differentiation – etiological confirmation) is proposed. Conclusion: a multiparametric laboratory approach and a standardized algorithm help to identify the cause of anemia early, reduce unjustified transfusions and prescription of erythropoiesis-stimulating agents, and individualize treatment strategy.