Chapter 70 Hematologic Manifestations of Cancer
Evaluation of Cytopenias
The evaluation of cytopenias can be difficult, particularly in the complex patient who has cytopenia before receiving chemotherapy that is worsened with treatment. The anemia of inflammation and the anemia of iron deficiency, both of which are microcytic, can be difficult to differentiate, particularly because the serum ferritin level is an unreliable assessment of iron stores in inflammatory conditions such as cancer (as reviewed in Chapter 9). Marrow-occupying tumors are often associated with microangiopathic features, including schistocytes, teardrops, and bizarre red cell forms, leukoerythroblastosis, and thrombocytopenia. The peripheral smear and laboratory evaluation can be difficult to distinguish from primary bone marrow disorders and thrombotic thrombocytopenic purpura (TTP), and in some cases a bone marrow examination may be necessary, particularly if the involvement of marrow has prognostic or treatment implications.
