Microangiopathic haemolytic anaemia in cancer patients with bone marrow infiltration

Leukoerythroblastic anemia in metastatic prostate cancer. Clinical and prognostic significance in patients with hormone-refractory disease

BACKGROUND

The clinical and prognostic significance of leukoerythroblastic anemia (LKEA) in patients with metastatic prostate cancer and, in general, patients with disseminated solid tumors is poorly understood. Therefore, the authors studied a population of patients with metastatic prostate cancer refractory to hormonal therapy to assess the incidence, clinical features, and prognostic implications of LKEA.

METHODS

The medical records of 106 patients with hormone-refractory prostate cancer metastatic to bone seen at the Tucson Veterans Affairs Medical Center between 1985 and 1991 were reviewed retrospectively. The clinical and laboratory data, number of packed erythrocyte transfusions required, and length of survival from the time of diagnosis of hormone-refractory disease until last follow-up visit or death were investigated in 91 identified patients.

RESULTS

Twenty-six of 91 patients (28.6%) were found to have LKEA. LKEA developed before or at the time of diagnosis of hormone-refractory disease in 8 patients and after diagnosis of hormone-refractory disease in 18 patients. The presence of LKEA was associated with significantly lower hemoglobin levels and platelet (Plt) counts and significantly higher total bilirubin, lactic dehydrogenase (LDH), and alkaline phosphatase values (P < 0.05). Leukopenia (< 4.0 x 10(9)/l leukocytes), thrombocytopenia (< 150 x 10(9)/l Plt), elevated LDH levels (> 220 U/l), and laboratory evidence of disseminated intravascular coagulation (DIC) were more common in patients with LKEA than in those without LKEA (P < 0.01). Microangiopathic hemolysis was seen in only 2 of 91 patients (2.1%). Patients with LKEA had significantly greater transfusion requirements compared with patients without LKEA (P < 0.0001), but the median survival length was not significantly different (9 months versus 11 months, respectively). The presence of DIC and LDH levels of 500 U/l or greater in patients with LKEA was associated with a poor prognosis.

CONCLUSIONS

LKEA is a relatively common finding in patients with hormone-refractory metastatic prostate cancer and is associated with greater transfusion requirements. Its presence, however, does not affect survival significantly.

Heparin treatment of microangiopathic haemolytic anaemia associated with an experimental tumour

In rats bearing the solid Walker 256 carcinosarcoma microangiopathic haemolytic anaemia (MHA) developed during the course of tumour growth. A phase of hypercoagulability was followed by a significant decrease in plasma fibrinogen, platelet count and antithrombin III. A diminished haematocrit and a rise in plasma haemoglobin and schistocyte count were accompanied by fibrin deposits in the tumour vessels. When the rats were treated with heparin during the growth of the Walker tumour, both DIC and MHA were prevented except of the last period of the experiment. The tumour sizes, however, did not differ in the controls and the heparinized animals. There is a fair amount of evidence to suggest that the MHA was induced by a tumour-dependent DIC which was blocked by heparin over a certain time period. In contrast, the tumour growth was not modified by effective suppression of DIC and MHA.