The present study was undertaken to identify the haematological abnormalities in patients with various types of solid tumors. In our study, anemia was found to be an important hematological finding in almost every malignancy. In our study on 98 newly diagnosed solid tumor patients, we found anemia was present in 89 (90.82%) patients. This frequency was close to the reports by other studies by [1, 2, 6, 7].
We classified anemia according to the WHO classification. We found that the maximum number of patients (48.98%) had mild anemia. 32.65% had moderate anemia and 9.18% had severe anemia. This is in accordance with a study, who also reported maximum number of patients had mild anemia, followed by moderate and severe anemia [5].
We further found, out of 98 patients, 65 were normocytic, 21 were microcytic and 12 were macrocytic. Similarly, a study from China also reported 68.6% cases were normocytic [8]. Further, we found 53 patients were normocytic hypochromic and 12 were found to be normocytic normochromic. 21patients were microcytic hypochromic. We found normocytic hypochromic to be the most common, which is different from other studies who found normocytic normochromic the most common type of anemia [1, 2].
The prevalence of anemia was also determined by tumor type. Higher prevalence of anemia was reported in GIT and gynecological tumors. This could be due to unperceived and long term bleeding occurring in stomach or colon or due to vaginal bleeding in females. Our study demonstrated that 14 out of 89 anemic patients (15.73%) had GIT tumor, 13 patients (14.60%) had gynecologic tumor, 12 (13.48%) had tumor of larynx and 9 (10.11%) anemic patients had tumor of breast and lung, followed by other tumors. Our finding is in close agreement with reports from China [8], wherein gastric cancer was most common (38.02%) followed by colorectal (23.13%) and in Australia, where gynecological cancers (65%) were the most common. Although our finding is lower in comparison with reports from Ethiopia, Europe and Australia who revealed 37.7%, 49.1% and 65.5% of gynecological cancer patients were anemic respectively [9, 10, 11] but still is in close agreement with the fact that GIT and gynecological tumor patients are mostly anemic. This difference in the frequency of anemic patients may be due to the difference in the definition of anemia and study design used.
Thrombocytopenia and thrombocytosis are other complications among the patients with solid tumors. The measurement of platelet counts may be a useful clinical marker associated with the prognosis of solid tumors. We found 33 (33.67%) patients had thrombocytopenia. Out of these 33 patients, 19 patients had platelet count < 1.0 lakh/mm3. Sun et al., [12] also found 11% cases had thrombocytopenia, out of which 4 cases had platelet count < 1.0 lakh/mm3. When distributed according to the tumor site, we found that thrombocytopenia was most common in breast cancer patients (18.18%), followed by stomach (12.12%), lung, tongue and prostrate (9.09% each). Thrombocytopenia has been correlated with poor prognosis in different solid tumor types including cancers of the breast, lung, ovaries, as well as colorectal cancer and has been reported to be a greater risk of hemorrhagic complications.
We found only 3 out of 98 patients had thrombocytosis, which included cancer of urinary bladder, tongue and larynx. This is in contrast with other two studies who have reported thrombocytosis in 34% and 36% cases [1, 2]. The lower frequency of thrombocytosis in our study could be because of the reason that higher platelet counts are associated with advanced tumor stage and since our patients included were diagnosed at early stage, hence the low frequency.
Elevation of the white cell count (leukocytosis) has also been reported in various types of non-hematological malignancies. In our study, leukocytosis was detected in 19 out of 98 patients (19.38%) in various solid tumors at the time of diagnosis. Other studies have also observed 20%, 30% and 33.3% leucocyte count as in solid tumors [2, 4, 13]. We further found that among leukocytosis, neutrophilia was seen in 78.94% patients. This is in agreement with other studies who also reported patients with leukocytosis had neutrophillic predominace of 29%, 60% and 96% [1, 2, 13].
A marked difference in the incidence of increased number of WBC has been shown in malignancies of different histological origin. Leucocytosis was found to be more prevalent among the lung cancer patients in our study. We found leukocytosis in 31.57% of lung cancer patients. Similar results were obtained by various authors who reported leukocytosis to be prevalent in 35% patients with lung cancer [14, 15].