الفهرس 
IntroductionOnly 14 pages are availabe for public view
 |  | from | 177 |  |  |
| | | from | 177 | | |
Abstract
S
UMMARY
linically, cancer-related anemia is classically normochromic and normocytic anemia with reticulo-cytopenia, In 30-60% of the cancer patients despite associating iron deficiency, serum iron values are within normal range for age together with decreased total iron binding capacity (TIBC), as well as elevated serum ferritin level and transferrin saturation index (TSI).
The pathogenesis of anemia in cancer patients is multifactorial; which can be attributed to either the direct tumor cell bone marrow infiltration, cancer therapy owing to the myelosuppressive effects of the chemotherapy either alone or in combination with radiotherapy, and sometimes due to nutritional deficiencies.
Cancer related anemia (CRA) is now recognized as an immune mediated disorder as a consequence of tumor cell population interaction with the immune system; resulting in exaggerated expression of specific inflammatory cytokines with the resultant shortened red blood cells (RBCs) survival, depression of erythroid precursors, defective iron utilization, and impaired erythropoietin production and function.
This inflammatory dys-regulation results in the development of the true CRA via suppression of the medullary erythroid precursor, decreasing erythropoietin (EPO) hormone production as well as impairing body iron metabolism.
C
Summary
103
Cancer cells mediates the activation of immune cells particularly the macrophages and with the secretion of interleukins primarily interleukin 6 (IL-6), as well as secretion of the tumor necrosis factor alpha (TNF-α), interferon gamma (IFN-γ).
Treatments for anemia in cancer patients, with restoration of the normal hemoglobin concentrations; optimizes blood the oxygen carrying capacity, resulting in improvements of anemia-related symptoms and patient’s quality of life (QoL).
The best treatment approach for anemia in cancer patients is a multimodal therapy approach aiming at correcting all possible underlying mechanisms.
The aim of this study was Evaluate of IL 6 levels status in children and adolescents presenting with suspected malignant solid tumors-related anemia. And recognize the iron status among those patiens, as well as; the frequency and possible causes of anemia in pediatric malignant solid tumors.
The study was conducted at Pediatric department, Hematology- Oncology clinics, Ain Shams Hospitals. The study included 30 children and adolescents with malignant solid tumors and anemia.
This cohort was further subdivided into 4 groups, group I: Patients with transferrin was less than 20 and ferritin was less than 30, group II; Patients with transferrin less than 20 and ferritin 30- 100, group III patients with transferrin less than 20 and ferritin was more than 100 functional iron deficiency, and
Summary
104
group IV; patients with transferrin more than 20 and ferritin was more than 100 anemia not related to iron.
The results of our present study can be summarized as follows: Our current study included 12 females (40.0%) and 18 males (60%) with age ranged from 2 – 17 years and with median (IQR) of 6 (2.5 – 10). Socioeconomic state was upper middle 1(3.3%), lower middle 8(26.7%), upper lower 14(46.7%) and lower 7(23.3%). As for the anthropometric measurements, WT/age and HT/ age SDS were -0.5 (-1-1_ and 0 (0-1) respectively, with no statistically significant difference (p value > 0.05) between group I+II and group III+IV regarding demographic data and anthropometric assessment. Current study demonstrated variability regarding the iron profile of the studied cohort with TSI and ferritin median (IQR) of 25 (19-29) and 40 (29.9-83.7) among patients in group I and II (n=11), while it showed results of 32 (28-37), and 186 (129.8-540) respectively among patients of group III and IV (n= 19) reflecting a state of functional iron deficiency. Hgb transfion in all patients with 55% requiring PRBC transfusions (77% of patients starting with baseline Hgb < 12 g/dL vs 47% of patients with baseline Hgb > 12 g/dL)
Summary
105
Our study showed that the range of 24 hours iron intake of the studied patients 4.97 – 9.61 with 80% (n=24) demonstrating in adequate daily iron intake. Distribution of solid tumors according to diagnosis among studied patients were brain tumor was n=8(26.7%), HRNBL n= 7 (23.3%), Retinoblastoma, RMS n=4(13.3%), bone sarcoma n=2 (6.7%), NRSTS n=2(6.7%), and GCT, NPC, WILM’S TUMOR n=1(3.3%), with no statistically significant difference between groups I+II and group III+IV regarding percentage of each diagnosis Regarding the complete blood counts of the studied patients; it showed (mean ± SD) of hemoglobin, RBCs count and MCV, ANC and PLT count of (9.21 ± 1.33), (3.71 ± 0.62), and (75.15 ± 7.55) respectively, while ANC, PLT, Retics and CRP median (IQR) were 3.64 (2.3 – 8.6), 307.5(225 – 373), 0.8 (0.4 – 1.6), and 23.75 (6.2 – 67) respectively. There was no statistically significant difference found between the two studied groups regarding laboratory parameters. Our study showed that serum iron ranged from 44 -228 (ug/dl), serum ferritin ranged from 21.2 – 866 (ng/dl) and TIBC (ug/dl) was TIBC (ug/dl) with no statistically significant difference between group I+II and group III+IV regarding 24 hours iron intake (p= 0.149). Our current study showed that there no statistically significant difference between groups I+II and group
Summary
106
III+IV regarding signs and symptoms of anemia, Also there was no statistically significant difference found between the studied groups regarding percentage of patients received chemotherapy and radiotherapy with p-value = 0.612 and 0.439; respectively., with no statistically significant difference found between both groups regarding duration since last chemotherapy received and history of previous operations with p-value = 0.108 and 0.447; respectively. Our study showed no statistically significant difference found between both groups regarding serum iron and IL-6 levels with p-value = 0.162 and 0.561; respectively. Our study showed that no statistically significant difference between both groups regarding bone marrow result and iron status in bone marrow with p-value = 0.648 and 0.120; respectively. Also no statistically significant correlation found between hemoglobin level and age, plt, retics, TLC, neutrophils, MCV, MCH, heart rate, and 24hours from iron intake. Our study showed that there was no statistically significant correlation found between hemoglobin level and serum iron, S. ferritin, TIBC, TSI and IL6 level. In our current study showed that there was no statistically significant relation found between hemoglobin level and chemotherapy, blood transfusion, timing of blood transfusion, bone marrow status, iron status in bone
Summary
107
marrow history of bleeding at time of presenting anemia and history operation. Our current study linear regression analysis of the duration since last chemotherapy received was the most important factor associated with the level of serum ferritin among the studied patients with (p-value 0.029). Also there was no statistically significant relation found between serum ferritin and the other studied parameters except statistically significant increase in the level of serum ferritin in patients with bone sarcoma than those without with (p-value = 0.046). In our current study showed that there was no statistically significant correlation found between IL-6 and Hgb, MCV, PLT, serum ferritin, and iron.