The Pattern of Anemia in Pediatric Solid Tumors Prior to and after Chemotherapy- A Retrospective Cohort Study

Abstract

Background: Solid pediatric tumors refer to cancers that affect children and adoles-cents, and they present unique challenges due to their distinct biological characteristics and their vulnerability to young patients. This study aims to shed light on addressing anemia and the causes of anemia in patients with solid pediatric tumors. Materials and Methods: This retrospective cohort comprised 200 healthy children as controls and 235 patients with solid tumors. The study was conducted at first Affiliated Hospital of Zhengzhou University between January 2020 and June 2023. We evaluated different parameters of blood components in controls and patients with solid tumors such as medulloblastoma, neuroblastoma, rhabdomyosarcoma, germ cell tumors, hepatoblastoma and nephroblastoma before and patients with only these tumors 3 weeks after the first cycle of chemotherapy. Further, we evaluated the relationship between serum ferritin and the weight of patients and assessed the relationship be-tween anemia and metastasis to the bone marrow in patients with neuroblastoma and hepatoblas-toma. objective: Objective of the study is to assess the anemic condition in multiple solid tumors and the importance of addressing anemia as a modifiable factor in pediatric oncology. Results: We observed various combinations of derangements in blood parameters such as hemo-globin, red blood cells, mean corpuscular volume, mean corpuscular hemoglobin, mean corpuscu-lar hemoglobin concentration, hematocrit, red cell distribution width, white blood cells, and plate-let in medulloblastoma, neuroblastoma, rhabdomyosarcoma, germ cell tumors, hepatoblastoma and nephroblastoma before and 3 weeks after first cycle of chemotherapy. We found a significant correlation between serum ferritin levels and weight in neuroblastoma patients who are ≤ 2 years (p = 0.022). Involvement of tumor cells in bone marrow correlates with decreased Hb levels in both neuroblastoma (CI = 93.21-106.68, p = 0.001) and hepatoblastoma (CI = 113.36-121.00, p = 0.001). Conclusion: Anemia may manifest as an early symptom in neuroblastoma, hepatoblastoma, and nephroblastoma. Also, anemia may be worse in patients with neuroblastoma and hepatoblastoma after chemotherapy and might warrant anemia therapy. result: We compared blood parameters of control and patients with solid tumors before chemotherapy and found that decreased HB level, RBC level and HCT level in neuroblastoma and hepatoblastomas, decreased MCV level and MCH in hepatoblastoma and nephroblastoma and increased RDW level was found only in neuroblastoma comparing to control patients. We observed specific parameter changes of blood in the case of neuroblastoma and hepatoblastoma with pediatric patients after chemotherapy. RBC, MCV, MCH, WBC, and PLT were decreased in neuroblastoma with pediatric patients and MCV, MCH, WBC and PLT were decreased in hepatoblastoma with pediatric patients after chemotherapy compared to before chemotherapy. We found a significant correlation between serum ferritin (FERR) levels and with weight of patients with neuroblastoma in a group of ≤ 2 years. Involvement of tumor cells in bone marrow correlates with decreased Hb level for patients with both neuroblastoma and hepatoblastoma.