Clinical Study On Iron Deficiency In Cancer-Related Anemia

Objective:To explore serum iron element,soluble transferrin receptor(sTfR)iron deficiency related indexes such as testing for cancer-related anemia(CRA)of clinical significance.Methods:83 patients with cancer-related anemia admitted to Affiliated Hospital of Chengde Medical University from July 2017 to February 2019 were selected,including 20 patients with functional iron deficiency,12 patients with absolute iron deficiency(AID),and 51 patients with iron replete 32 cases of iron-deficiency anemia(IDA)patients,with normal 39 cases as control group.A total of 154 objects were tested with c-reactive protein(CRP),hemoglobin(Hb),mean corpuscular volume(MCV),mean corpuscular hemoglobin concentration(MCHC),reticulocyte hemoglobin,CHr),reticulocyte percentage(RET),soluble transferrin receptor(sTfR),ferritin(SF),transferrin(Tf),Serum iron,(SI),Hepcidin and erythropoietin(EPO),and computing ferritin index value.The results were analyzed by SPSS22.0 statistical software.One-way anova was used for the comparison among multiple groups,and SNK test was used for the comparison between groups.When test levels were P<0.05,indicating that the differences were statistically significant.Results:1 Comparison of age and gender differencesThere was statistical significance between the iron-deficiency anemia group and the cancer-related anemia group and the control group(P<0.05),while there was no statistical significance between the cancer-related anemia group and the control group(P > 0.05).The median age of the iron deficiency anemia group was lower than that of the above groups,and the majority was female.2 Comparison of MCHC differences among groupsIron deficiency anemia group(91.68±5.19g/L),cancer-related anemia group(321.60±30.39g/L)and control group(335.79±11.12g/L)have statistical significance(P<0.05);functional(331.94±10.24g/L)and absolute(303.66±22.76g/L)iron deficiency groups in the control group and the iron replete group(303.25±25.29g/L)showed no statistical significance(P<0.05),and no statistical significance was found in the functional and absolute iron deficiency groups(P > 0.05).3 Comparison of SI differences among groupsIron deficiency anemia group(4.66±3.01umol/L),cancer-related anemia group(11.50 ± 10.88umol/L)and control group(15.49 ±7.22umol/L)have statistical significance(P<0.05);There was no statistical significance between the iron deficiency anemia group,the functional iron deficiency group(7.60±9.36umol/L)and the absolute iron deficiency group(7.78±10.18umol/L)(P > 0.05).4 Comparison of Tf differences among groupsIron deficiency anemia group(3218.43±608.43mg/L),cancer-related anemia group(1927.01±558.97mg/L)and control group(2503.85±442.81mg/L)have statistical significance(P<0.05);there was no significant difference in functional iron deficiency group(1780.33±533.95mg/L)and iron replete group(1911.20±530.03mg/L)(P > 0.05).5 Comparison of sTfR differences among groupsIron deficiency anemia group(3218.43±608.43mg/L),cancer-related anemia group(1927.01±558.97mg/L)and control group(2503.85±442.81mg/L)have statistical significance(P<0.05);there was no statistical significance between functional iron deficiency group(1780.33±533.95mg/L)and absolute iron deficiency group(1911.20±530.03mg/L)(P > 0.05).6 Comparison of the hepcidin differences between the groupsThe cancer-related anemia group(104.68±40.71ng/mL)has statistical significance with the control group(85.98±34.48ng/mL)and the iron deficiency anemia group(98.44±49.79ng/mL)(P<0.05),and there was no statistical significance between the iron deficiency anemia group and the control group(P > 0.05).there was no statistical significance between the functional iron deficiency group(1780.33±533.95ng/mL),iron replete group(2330.83±599.61ng/mL)and absolute iron deficiency group(1911.20±530.03ng/mL)(P > 0.05).7 comparison of EPO differences among groupsThe cancer-related anemia group(129.98±167.84mIU/mL)has statistical significance with the control group(10.64±5.74mIU/mL)(P<0.05),and there was no statistical significance between cancer-related anemia group and iron deficiency anemia group(153.89±196.52mIU/mL)(P > 0.05).8 Correlation between iron deficiency related indicatorsThere is a strong correlation between CHr,FI,sTfR and MCHC,specifically:CHr is negatively correlated with FI(r=-0.663,P=0.000),CHr is negatively correlated with sTfR(r=-0.735,P=0.000),CHr is positively correlated with MCHC(r=0.700,P=0.000),FI is positively correlated with MCHC(r=0.548,P=0.000),sTfR is negatively correlated with MCHC(r=-0.617,P=0.000),and FI is positively correlated with Tf(r=0.616,P=0.000).Hepcidin was moderately correlated with SF(r=0.341,P=0.000),slightly correlated with EPO(r=0.196,P=0.000)and Tf(r=-0.201,P=0.000),but not with other indexes.Conclusion:1 There were significant differences in sTfR,MCHC,Tf and SI between the cancer-related anemia group and the iron-deficiency anemia group and the control group.The relationship among the three groups was helpful to determine the type of iron deficiency in patients.2 Functional iron deficiency group,the absolute iron deficiency,iron replete group with iron deficiency anemia group and the control group significant differences in the sTfR,through three groups before and after the differences of two groups in the sTfR,helps to identify functional iron deficiency,the absolute iron deficiency,iron replete patients with iron deficiency anemia patients and normal people,absolute iron deficiency group and functional iron deficiency,iron replete group there were significant differences in Tf,helps to identify patients with CRA different metabolic state of iron.3 The EPO level of CRA patients was not significantly different from that of the control group and IDA group,suggesting that the EPO level of CRA was normal,while anemia was considered to be related to the decreased response of bone marrow hematopoietic tissue to EPO.There were significant differences in hepcdin and sTfR between FID,AID and iron replete group and control group and IDA group,suggesting that although iron metabolism was different,the hepcidin level of cancer patients was higher than that of normal people with iron-deficiency anemia and normal people,while sTfR was higher than normal people and lower than that of IDA patients.4 There was a strong correlation between CHr,FI,sTfR and MCHC,suggesting that changes in erythrocyte morphology and changes in serological indexes were helpful to understand the different association between cancer patients and IDA patients and normal people.5 The comprehensive application of iron metabolism can be used to distinguish the cancer-related anemia from the iron-deficiency anemia,and the specific threshold can be further studied to guide the clinical diagnosis and treatment.