| disease | Digestive System Cancer with Blood Syndrome |
This syndrome refers to certain cancers of the digestive system, such as stomach cancer, intestinal cancer, pancreatic cancer, liver cancer, and gallbladder cancer, often accompanied by microvascular nature of disease hemolysis, as well as increases and decreases in blood cell components, resulting in a group of symptoms resembling hematologic disorders.
bubble_chart Etiology
1. Microangiopathic nature of disease Hemolytic anemia Mainly due to tumor components entering the bloodstream, activating the extrinsic coagulation system, leading to microvascular thrombosis or embolization, obstructing red blood cell circulation. The red blood cells are squeezed and ruptured, causing hemolysis. Peripheral blood smear examination reveals red blood cell fragments and abnormally shaped red blood cells, such as helmet-shaped, star-shaped, crescent-shaped, etc. Some also suggest it is related to membrane proliferation in pulmonary microvessels and microvascular tumor embolism. As platelets are consumed in large quantities during coagulation, thrombocytopenia occurs.
2. Polycythemia May be related to excessive erythropoietin production by tumors.
3. Leukemoid reaction Likely caused by massive tumor necrosis or metastasis to the bone marrow, or possibly due to tumor cells producing granulocyte growth factors. Most cases are granulocytic, primarily characterized by an increase in peripheral white blood cell count, reaching 5×109/L to 10×109/L, with the appearance of immature white blood cells.
4. Eosinophilia May be induced by an eosinophil chemotactic factor secreted by cancer cells.
5. Lymphocytic leukemoid reaction Elevated peripheral white blood cell count, with the majority being mature lymphocytes in the blood smear.
6. Erythroblastic anemia Caused by tumor invasion of the bone marrow, disrupting the barrier between the bone marrow and blood circulation. Nucleated red blood cells and numerous immature granulocytes can be observed in the peripheral blood.7. Thrombocytosis Increased platelet count, but usually not accompanied by thrombosis or bleeding.
8. Thrombotic thrombocytopenic purpura May result from tumor-induced intravascular coagulation and consumptive thrombocytopenia.
9. Intravascular coagulation and fibrinolysis
bubble_chart Clinical Manifestations
1. Microangiopathic nature of disease: Hemolytic anemia seen in stomach cancer, colorectal cancer, pancreatic cancer, and gallbladder cancer.
2. Polycythemia observed in liver cancer, etc. Patients exhibit reddish-purple skin and mucous membranes, conjunctival congestion, increased blood viscosity, slowed blood flow and congestion in various organs throughout the body, presenting symptoms such as headache, vertigo, fatigue, tinnitus, blurred vision, forgetfulness, limb numbness with stabbing pain, and profuse sweating.
3. Leukemoid reaction can be caused by colorectal cancer, pancreatic cancer, stomach cancer, and liver cancer.
4. Eosinophilia can be induced by liver cancer, pancreatic cancer, colorectal cancer, and stomach cancer.
5. Lymphocytic leukemoid reaction is observed in stomach cancer, etc.
6. Erythroblastic anemia can be caused by gastrointestinal cancers.
7. Thrombocytosis occurs in disseminated gastrointestinal cancers.
8. Thrombotic thrombocytopenic purpura can be seen in stomach cancer.
9. Intravascular coagulation and fibrinolysis are observed in pancreatic cancer, colorectal cancer, stomach cancer, and liver cancer. Clinically, bleeding is the main manifestation, with increased fibrin degradation products in the blood, resulting in a positive 3P test.
Leukemoid reactions have the following characteristics: (1) There is an underlying disease, and after treatment of the primary disease, white blood cells can return to normal; (2) Generally, there is no significant anemia or thrombocytopenia; (3) Granulocytes show severe toxic changes, with toxic granules and vacuoles in the cytoplasm; (4) The activity of neutrophil alkaline phosphatase and glycogen are significantly increased; (5) There is no Ph' chromosome in the cells. When diagnosing eosinophilia, parasitic infections caused by Chinese Taxillus Herb and allergic reactions leading to eosinophilia should be excluded.
bubble_chart Treatment Measures
The primary approach involves treating the underlying disease and managing symptoms. For polycythemia, the fundamental treatment is addressing the primary cancer. If polycythemia causes significant symptoms, options include phlebotomy and the use of drugs such as Maitong, Vinorelbine, and Salvia.
1. Polycythemia needs to be differentiated from polycythemia vera.
2. Leukemoid reaction needs to be distinguished from leukemia.
3. Lymphocytic leukemoid reaction should be differentiated from those caused by viral infections and pestilential mononucleosis.
4. Erythroblastic anemia must be distinguished from extramedullary hematopoiesis and erythroleukemia.
5. Thrombocytosis needs to be differentiated from thrombocytosis caused by other reasons.
