No abstract

BackgroundIn preoperative blood management of colorectal cancer patients, intravenous iron therapy is increasingly used to treat anaemia and prevent red blood cell transfusions. However, while iron deficiency is the most common cause of anaemia, little is known about the prevalence and namely type of iron deficiency in this population, whereas both types of iron deficiency (i.e. absolute and functional iron deficiency) are recommended to be treated differently by international cancer guidelines.ObjectiveThe aim of present study is to investigate the prevalence and namely type of iron deficiency in colorectal cancer patients, and to assess its clinical relevance.MethodsPreoperative iron status, clinical parameters (i.e. age, ASA classification, tumour location, tumour stage) and postoperative complications were retrospectively collected for all newly diagnosed colorectal cancer patients in our institution over a 3-year period.ResultsIron deficiency was observed in 163 (48.1%) of 339 patients. Of these iron-deficient patients, 3.7% had an isolated absolute iron deficiency (AID) and 15.3% a functional iron deficiency (FID), while the rest had a combination of AID and FID. Anaemia was present in 66.1% of iron-deficient patients. Iron deficiency was significantly associated with an increased postoperative complication rate (univariable OR 1.94, p = 0.03, multivariable OR 1.84, p = 0.07), with right-sided tumours (p < 0.001), high ASA classification (p = 0.002), advanced tumour stage (p = 0.01) and advanced age (p = 0.04). In comparing clinical parameters between patients with AID and FID, advanced age was significantly associated with FID (p = 0.03), and the presence of anaemia with AID (p = 0.02).ConclusionIn preoperative colorectal cancer patients, there is a high prevalence of iron deficiency, including a high percentage of patients with—a component of—functional iron deficiency, associated with the increased postoperative complication rate. As both types of iron deficiency require a different treatment strategy, our results illustrate the therapeutic potential of especially intravenous iron supplementation in patients with severe iron deficiency and stress the urgency of routinely monitoring preoperative iron status and differentiation between types of iron deficiency. As iron therapy may also be potentially harmful in respect to stimulation of tumour growth, future clinical trials assessing the long-term effect of iron therapy are necessary.

Implementation of IV iron therapy in anemic colorectal cancer patients leads to a distinct increase of preoperative Hb level. IV iron therapy is most effective in patients presenting with more severe anemia, and with higher transferrin and lower ferritin levels, markers for an absolute iron deficiency (ID), compared to functional ID.

No abstract

An SO-year-old man who initially presented with a left hemiparesis rapidly developed right-sided heart failure and died. Although an echocardiogram suggested the presence of a tumor, the diagnosis of a primary cardiac lymphoma was made only at autopsy. The tumor involved a leaflet of the tricuspid valve, a finding not previously reported in the literature. In 1977, the Armed Forces Institute of Pathology defined a primary malignant lymphoma of the heart as that involving only the heart and pericardium. Many reports of primary cardiac malignant lymphomas have been published, however, most of which mention the presence of metastases. We have reviewed the world literature to determine the number of actual cases of primary malignant lymphoma of the heart. Only 15 reported cases, including the current case, were found to meet the current criteria. Accepted for publication December 26, 1988. medications), hyperuricemia (treated with allopurinol), supraventricular tachycardia, and a normochromic normocytic anemia. Admission physical examination revealed a pulse of 100 beats per minute, respirations of 22 per minute, and a blood pressure of 160/100 mm Hg. He was afebrile. His head and eyes were deviated to the right, with intact doll's eyes and a questionable left field cut. He had a left central fifth and seventh nerve deficit. The chest was symmetrical without bony abnormality. There were bibasilar rales without evidence of consolidation or wheezes.A cardiac examination revealed a rocking motion on palpation with a summation gallop and a holosystolic murmur at the left lower sternal border. Carotid pulses were 2+ without bruits. There was no jugular venous distention. Abdominal, genitourinary, and rectal examination were unremarkable. The extremities were without clubbing, cyanosis, or edema. Motor examination revealed 5/5 strength on the right side. On the left, there was 3/5 strength in both upper and lower extremities, and muscle development was appropriate for age. There was increased muscle tone ofthe left upper and lower extremities. His reflexes were brisk and symmetric. There were crossed adductor responses bilaterally as well. Coordination, station, and gait were not tested.The admission computed tomography scan (CT scan) of the head showed only moderate cortical atrophy, as seen on CT scan performed 1 year previously. An elecrocardiogram (EKG) revealed sinus tachycardia, first degree atrioventricular block, and nonspecific ST-T changes. A chest radiograph showed prominent pulmonary vasculature and blunting of the right a stovertebral angle. There was a marked increase in the sue of the heart since the most recent film was taken 1 year earlier. Liver function tests were elevated with an aspartate aminotransferase (AST) of 406 U/1 (normal, 26-88); alanine aminotransferase (ALT) of 197 U/1 (normal, 10-60), and alkaline phosphatase of 52 1

No abstract

No abstract

In colorectal cancer patients, iron therapy, and especially intravenous iron therapy, is increasingly used to treat anemia and reduce the use of blood transfusions. However, iron has also been shown to be an essential nutrient for rapidly proliferating tissues and cells. In this respect, anemia of inflammation, characterized by limited duodenal iron uptake and sequestration of iron into the reticuloendothelial system, might be regarded as a potentially effective defense strategy of the human body against tumor growth. We therefore hypothesize that iron therapy, by supporting colorectal tumor growth and increasing the metastatic potential, may worsen tumor prognosis in colorectal cancer patients. This hypothesis is particularly supported for colorectal cancer by laboratory, epidemiological and animal studies, demonstrating the role of iron in all aspects of tumor development growth. Compared to non-malignant colon cells, tumor cells differ in the levels and activity of many iron import and export proteins, resulting in an increase in intracellular iron level and enhanced proliferation. In addition, it is demonstrated that iron is able to amplify Wnt signaling in tumors with Apc mutation, a critical mutation in the development of colorectal cancer. If our hypothesis is to be confirmed, current practice of iron administration, as treatment for anemia and as replacement of blood transfusions, can be hazardous and should be completely reconsidered.