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Radiation Therapy Effects on Iron Metabolism and Anemia

Radiation therapy (RT) can induce iron deficiency and anemia through multiple mechanisms:

Mechanisms

  1. Bone Marrow Suppression: RT fields encompassing pelvis, spine, ribs, sternum irradiate active marrow → ↓ erythropoiesis → normocytic/normochromic anemia. Dose-dependent; >20–30 Gy causes significant myelosuppression.
  2. GI Mucositis/Malabsorption: Abdominal/pelvic RT damages duodenal/jejunal mucosa → ↓ iron absorption (heme & non-heme). Chronic blood loss from radiation proctitis/enteritis → iron loss.
  3. Inflammation: RT → cytokine release (IL-6, TNF-α) → ↑ hepcidin → ferroportin degradation → iron sequestration in macrophages (functional iron deficiency).
  4. Nutritional Intake: Odynophagia, nausea, taste changes → reduced intake.

Monitoring & Management

  • CBC, ferritin, TSAT, CRP q1–3 months during/after RT.
  • Oral iron if ferritin <100 ng/mL or TSAT <20% (but GI toxicity may limit).
  • IV iron (ferric carboxymaltose, iron sucrose) bypasses absorption; effective in inflammation.
  • Erythropoiesis-stimulating agents (ESAs) if Hb <10 g/dL on chemo/RT (per guidelines).
  • Treat bleeding (endoscopic argon plasma coagulation for radiation proctitis).

Multidisciplinary coordination (radiation oncology, hematology, GI, nutrition) optimizes hemoglobin and quality of life.

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