Paraneoplastic Hematologic Syndromes of Solid Tumors

Hematologic manifestations of solid tumors: mechanisms of erythrocytosis, leukocytosis, thrombocytosis, and coagulopathies, and laboratory diagnostic approaches.

Evgeny Zaytsev 2 min December 28, 2025

Title slide about hematologic manifestations of solid tumors

🩺 Tumors and their “invisible” effects: hematologic manifestations

Solid tumors can affect the body not only locally but also through paraneoplastic syndromes — conditions caused by the tumor’s secretion of biologically active substances. These manifestations often mimic other diseases, making diagnosis difficult.

🔍 Key Syndromes and their Mechanisms

Hypercalcemia 🦴

Cause: The tumor produces parathyroid hormone-related peptide (PTHrP), which enhances bone resorption and renal calcium retention.
Symptoms: Weakness, nausea, polyuria, confusion, arrhythmias.
“Culprit” Tumors: Renal cell carcinoma, hepatocellular carcinoma, small cell ovarian cancer.

Hypoglycemia (NICTH) 🍬

Cause: The tumor secretes insulin-like growth factor 2 (IGF-2), which mimics insulin action.
Symptoms: Morning weakness, sweating, seizures, loss of consciousness.
Tumors: Solitary fibrous tumors, sarcomas.

Erythrocytosis 🩸

Cause: Excess erythropoietin, stimulating the bone marrow.
Symptoms: Headache, dizziness, skin redness.
Tumors: Renal cell carcinoma, hemangioblastoma.

Leukocytosis and Thrombocytosis 📈

Cause: Cytokines (e.g., G-CSF) activate blood cell growth.
Symptoms: Fever, fatigue, risk of thrombosis.
Tumors: Hepatoblastoma, inflammatory myofibroblastic tumors.

Coagulopathy ⚠️

Cause: DIC syndrome or immune thrombocytopenia.
Symptoms: Bleeding, petechiae, hematomas.
Tumors: Neuroblastoma, kaposiform hemangioendothelioma.

🏥 Management Tactics

Diagnosis: Laboratory tests (PTHrP, IGF-2, erythropoietin), imaging (ultrasound, CT/MRI).
Treatment:
Correction of metabolic disorders (hydration, glucose, anti-resorptive drugs).
Surgical removal of the tumor — the main method for eliminating paraneoplastic effects.

💡 Important! In children and young patients, these syndromes are rare but require special attention due to the risk of delayed diagnosis.

Source: Shnawa GN, Cameron DB. Surgical Management of Solid Tumors With Hematologic Manifestations: A Mechanism-Based Clinical Review. European Journal of Haematology. 2025.