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<p>Prevalence of Anemia in Patients with Multiple Myeloma: Case Series Reports</p> <p>Fernando Luiz Affonso Fonseca, et al., BAOJ Hematol 2017 1: 11: 001</p> <p>BAOJ Hematol, an open access journal Volume 1; Issue 1; 001</p> <p>Thais Moura Gscon Belardo1, Samantha Sanches de Carvalho1, Ligia Ajaime Azzalis2, Alexandre Luiz Affonso Fonseca1, Edimar Cristiano Pereira2 and Fernando Luiz Affonso Fonseca1,2*</p> <p>1Laboratrio de Anlises Clnicas da Faculdade de Medicina do ABC, Santo Andr, SP, Brazil2Universidade Federal de So Paulo, Diadema, SP, Brazil</p> <p>BAOJ Hematology</p> <p>*Corresponding author: Fernando Luiz Affonso Fonseca, Universida-de Federal de Sao Paulo, Diadema, SP, Brazil, E-mail: profferfonseca@gmail.com </p> <p>Sub Date: December 26, 2016, Acc Date: January 3, 2017, Pub Date: January 3, 2017.</p> <p>Citation: Thais Moura Gscon Belardo, Samantha Sanches de Carvalho, Ligia Ajaime Azzalis, Alexandre Luiz Affonso Fonseca, Edimar Cristiano Pereira, et al. (2017) Prevalence of Anemia in Patients with Multiple Myeloma: Case Series Reports. BAOJ Hematol 1: 001.</p> <p>Copyright: 2016 Fernando Luiz Affonso Fonseca, et al. This is an open-access article distributed under the terms of the Creative Com-mons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.</p> <p>Case Report</p> <p>AbstractThe Multiple Myeloma (MM) is a progressive and incurable neoplastic disease of B cells. It represents 1% of all malignancys and is the second most common hematologic malignancy, accounting for 10% of cases. Anemia is a common complication in patients with MM and occurs in two-thirds of the patients at diagnosis. The anemia shows low intensity to moderate (hemoglobin between 9 and 12 g/dl ), and rarely the hemoglobin level is below 8 g/dL. The hematocrit varies from 25% to 40%. </p> <p>In this study it was evaluate the results of laboratory tests of 25 patients with Multiple Myeloma treated by the ambulatory of onco- hematology from Faculty of Medicine ABC (Brazil) from january 2013 to november 2015 in order to assess the prevalence of anemia (characterized by hemoglobin low values).</p> <p>Keywords: Anemia; Multiple Myeloma; Hemoglobin</p> <p>Case ReportMultiple myeloma (MM) is a progressive and incurable B cell neoplasm, characterized by dysregulated and clonal proliferation of plasma cells in the bone marrow (MO), which produces and secretes monoclonal immunoglobulin (Ig). The M protein proliferates in the MO and often invades the underlying bone, therefore promoting bone destruction (osteopenia, osteolysis and pathological fractures) and clinically manifesting as an important bone pain and hypercalcemia. The production and secretion of M protein also contribute to the onset of anemia, renal insufficiency and immune suppression present in the MM [1,2].</p> <p>This disease is predominantly manifested in elder patients with a median age of 65 years, and rarely affects people under 40 years old. The development of more specific techniques of treatment, diagnosis, and the growing number of elders in the general population may explain in part the increasing incidence in the last decades. The tendency of maximization in the frequency of Multiple Myeloma in patients under 55 years old is related to important environmental factors of the last 60 years [3,4]. MM represents 1% of all malignant neoplasms, being the second most common hematologic malignancy, corresponding to 10% of the cases, losing only to non-Hodgkins lymphomas [5].</p> <p>The annual incidence of MM in the United States in 2003 was 4 to 100,000. Little is known about the incidence and clinical aspects of MM in ethnic groups in Latin America, where, for several centuries, a relatively free miscegenation has occurred between </p> <p>native American, Mediterranean and African ancestors. In Brazil, for example, the incidence of MM is unknown, since the disease does not appear in the annual estimation provided by the National Cancer Institute [6,7].</p> <p>Anemia may be one of the early signs of a neoplastic disease, but more commonly it is related to anti-neoplastic treatment or disease progression. Its development in patients with cancer is multifactorial. Different mechanisms, such as blood loss, increased red blood cell destruction or decreased production, may coexist in the same patient [8]. Furthermore, Anemia is defined as a pathological condition due to the decrease in the number of red blood cells or the concentration of hemoglobin, causing a decrease in tissue oxygenation. It is a frequent complication in cancer patients since up to 70% of them acquire anemia at some point during their illness or treatment. The incidence and severity of anemia depends on the type of tumor, the age of the patient, the stage of the disease and the type and intensity of the treatment [8,9].</p> <p>Major importance should be given to the treatment of anemia in cancer patients, especially in patients with Multiple Myeloma (MM), since symptoms related to anemia, especially fatigue and lethargy, are often underestimated or attributed solely as a consequence of Neoplastic disease or the chemotherapy treatment instituted [9].</p> <p>The aim of this study was to determinate the prevalence of anemia in MM patients treated at Clinical Laboratory Analysis from School laboratory. The Blood Count Cells Tests were performed on Pentra 120 Horiba machine under the supervision of the analyst responsible and confirmed in slides cells reading whenever necessary. The analysis of the results obtained were related to the </p> <p>BAOJ Hematol, an open access journal Volume 1; Issue 1; 001</p> <p>Citation: Thais Moura Gscon Belardo, Samantha Sanches de Carvalho, Ligia Ajaime Azzalis, Alexandre Luiz Affonso Fonseca, Edimar Cristiano Pereira, et al. (2017) Prevalence of Anemia in Patients with Multiple Myeloma: Case Series Reports. BAOJ Hematol 1: 001.</p> <p>Page 2 of 3</p> <p>last three hematological examinations performed by each of the patients. At the end of the triage and data collection, twenty five patients remained of whom the individual mean and the general mean were calculated. Then, were showed the results of laboratory tests from 25 patients with Multiple Myeloma who were treated from January 2013 to November 2015 were analyzed.</p> <p>The search shows that hemoglobin of the patients studied ranged from 5.3 g /dL to 16.0g /dL, with an average of 11.0 g /dL (SD = 2.3). Regarding the age group, they ranged from 48 to 86 years old, predominantly of patients over sixty years old, with 76% (n = 19). The male gender presented a discrete predominance among the studied patients, with 56% (n = 14).</p> <p>Table 1 shows the results of the mean and standard deviation, with maximum and minimum values found. The quantification </p> <p>Patients Hemoglobin Quantification Values by Flow Cytometry (PENTRA 120)</p> <p>1 2 3 Individual Average</p> <p>1 6.7 7.4 8.3 7.5</p> <p>2 9.3 11.8 10.6 10.6</p> <p>3 9.8 13.1 13.0 12.0</p> <p>4 10.6 10.8 10.1 10.5</p> <p>5 8.4 8.9 8.6 8.6</p> <p>6 14.2 13.2 13.0 13.4</p> <p>7 10.4 10.6 11.7 10.9</p> <p>8 15.4 15.1 15.0 15.2</p> <p>9 13.7 13.6 13.7 13.7</p> <p>10 14.3 13.5 13.6 13.8</p> <p>11 12.1 14.0 13.6 13.2</p> <p>12 10.8 11.3 10.5 10.9</p> <p>13 6.1 7.7 5.3 6.4</p> <p>14 10.4 10.1 9.3 9.9</p> <p>15 10.2 10.0 10.0 10.0</p> <p>16 11.3 12.8 13.1 12.4</p> <p>17 11.0 10.8 11.0 10.9</p> <p>18 10.4 9.8 10.2 10.1</p> <p>19 7.0 7.6 7.1 7.2</p> <p>20 8.0 7.7 9.9 8.5</p> <p>21 10.8 10.9 10.8 10.8</p> <p>22 13.7 11.3 11.3 12.1</p> <p>23 8.1 9.4 8.7 8.7</p> <p>24 16.0 13.8 13.0 14.2</p> <p>25 12.8 12.0 12.2 12.3</p> <p>AVERAGE </p> <p> S D</p> <p>10.9</p> <p>2.7</p> <p>11.1</p> <p>2.2</p> <p>10.8</p> <p>2.3</p> <p>10.9</p> <p>2.3</p> <p>Table 1: Hemoglobin (Hb) results of patients with Multiple Myeloma</p> <p>of Hemoglobin was evaluated in three different periods of the disease. </p> <p>This study evaluated the hematological status of patients with Multiple Myeloma treated by the hematology clinic of the Faculty of Medicine of ABC in order to verify the prevalence or not of chronic anemia (characterized by hemoglobin quantified below 11 g/dL).</p> <p>It was noted that the patients in this study were elderly (over 60 years old ) with a discrete male predominance. </p> <p>Sixty percent of the patients studied had hemoglobin values lower than 12.0 g/dL in the calculation of the individual mean (referring to the last three tests performed), and were therefore fitted into the clinical picture of anemia. The overall mean was 11.0 g/dL for </p> <p>BAOJ Hematol, an open access journal Volume 1; Issue 1; 001</p> <p>Citation: Thais Moura Gscon Belardo, Samantha Sanches de Carvalho, Ligia Ajaime Azzalis, Alexandre Luiz Affonso Fonseca, Edimar Cristiano Pereira, et al. (2017) Prevalence of Anemia in Patients with Multiple Myeloma: Case Series Reports. BAOJ Hematol 1: 001.</p> <p>Page 3 of 3</p> <p>quantification of hemoglobin dosage.</p> <p>The data analyzed showed the prevalence of anemia in patients with multiple myeloma, as revealed in the last three Blood Count Cells Tests of those patients, as described previously. The prevalence may be related to antineoplastic treatment or disease progression.</p> <p>Anemia is a common complication in patients with MM and occurs in two thirds of patients at diagnosis. The development of this condition in patients with MM is multifactorial and includes: bone marrow infiltration by neoplastic cells, myelosuppressive and nephrotoxic effect of chemotherapeutic drugs; Gastrointestinal bleeding induced by frequent use of non-hormonal anti-inflammatory drugs; Renal insufficiency, hemolysis, iron deficiency, decrease of folic acid and vitamin B12; Hemodilution secondary to hyperparaproteinemia and radiotherapy (when used in extended fields) [9,10].</p> <p>However, the main patho physiological mechanism responsible for anemia in MM has been attributed to the condition called chronic disease anemia (ADC). It is a clinical syndrome characterized by the development of anemia in patients with chronic, inflammatory or neoplastic infectious disease [9,10,11].</p> <p>Is important to determinate the prevalence of anemia in MM patients in individual conditions because its can be related to antineoplastic treatment or disease progression.</p> <p>References1. Kyle RA, Gertz MA, Witzig TE, Lust JA, Lacy MQ, et al. (2003) Review </p> <p>of 1027 patients with newly diagnosed Multiple Myeloma. Mayo Clin Proc 78(1): 21-33. Doi:10.4065/78.1.21.</p> <p>2. Silva PR, Brandao AMK, Pinto MVP, Faria DMR, Clementino DCN, et al. (2009) Mieloma mltiplo: caractersticas clnicas e laboratoriais ao diagnstico e estudo prognstico. Rev. bras. hematol. Hemoter 31(2): 63-68. DOI: 10.1590/S1516-84842009005000013.</p> <p>3. Silva OR, Faria DMR, Cortes WJCM, Clementino DCN, Faria RJ, et al. (2008) Mieloma mltiplo: verificao do conhecimento da doena em mdicos que atuam na ateno primria sade. Rev. Bras. Hematol. Hemoter. 30 (6): 437-444. Doi:10.1590/S1516-84842008000600004.</p> <p> 4. Ludwig H, Pohl, G. Osterborg, A (2004) Anemia in multiple myeloma. Clinical advances in hematology &amp; oncology H&amp;O 2(4): 233-241. </p> <p>5. Hussein MA, Juturi JV, Lieberman I (2002) Multiple Myeloma. Curr Opin Oncol 14(1): 31-5. </p> <p>6. (2014) Incidncia de Cancer no Brasil. Ministrio da Sade. Instituto Nacional do Cncer. Estimativa 2014: Incidncia de Cncer no Brasil Disponvel.</p> <p>7. Faria, MR, Silva OR (2007) Gamopatias monoclonais: critrios diagnsticos e diagnsticos differentials. Rev. Bras. Hematol. Hemoter 29(1): 17-22.</p> <p>8. Canado R D Chiattone, S (2002) Anemia de doena crnica. Rev Bras Hematol Hemoter. 24(2): 127-36. DOI:10.1590/S1516-84842002000200009.</p> <p>9. Canado RD,Chiattone (2007) Mieloma Multiplo e anemia.Rev.Bras.Hematol.Hemoter. 29 (1): 67-76.</p> <p>10. Poulos AR, Gertz MA, Pankratz VS, Post-White J (2001) Pain, mood disturbance, and quality of life in patients with multiple myeloma. Oncol Nurs Forum. 28 (7): 1163-70.</p> <p>11. Weiss G, Goodnough L (2005) Anemia of chronic disease. 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