Can a Meningioma Cause Anemia?
Meningiomas do not typically cause anemia as a direct consequence of the tumor itself, but anemia can occur in rare subtypes (lymphoplasmacyte-rich meningiomas) or as a secondary complication from surgical blood loss.
Direct Tumor-Related Anemia (Rare)
The only well-documented mechanism by which a meningioma directly causes anemia involves a rare histological subtype:
- Lymphoplasmacyte-rich (LPR) meningiomas are accompanied by prominent peripheral blood abnormalities including anemia and/or polyclonal gammopathy that resolve after surgical removal of the tumor 1
- This rare clinical entity behaves anomalously and is considered closer to intracranial inflammatory masses rather than typical meningiomas 1
- The anemia in LPR meningiomas appears to be paraneoplastic in nature, though the exact mechanism remains unclear 1
Indirect Associations with Anemia
Several indirect mechanisms may link meningiomas to anemia:
- Preoperative anemia (hemoglobin levels below normal) was present in 21% of meningioma patients in one series and showed a trend toward higher risk for tumor recurrence (HR 1.83; P = 0.06), though this likely represents a prognostic marker rather than a tumor-caused phenomenon 2
- Surgical blood loss during meningioma resection can be significant, as surgery is complicated by attachment to vessels and neurological structures 3
- Extramedullary hematopoiesis within a meningioma has been reported in one case of a patient with underlying chronic lymphocytic leukemia, but this represents hematopoietic tissue within the tumor rather than the tumor causing anemia 4
Clinical Pitfall
Do not assume a meningioma is causing anemia without investigating other causes. The vast majority of meningiomas (94% benign, 5% atypical, 1% malignant) do not produce systemic hematologic abnormalities 3. If anemia is present in a patient with meningioma:
- Evaluate for the rare LPR subtype if anemia is accompanied by polyclonal gammopathy 1
- Consider underlying hematologic disorders (as in the case report with chronic lymphocytic leukemia) 4
- Assess for other common causes of anemia in middle-aged to elderly adults (iron deficiency, chronic disease, etc.)
- Recognize that preoperative anemia may indicate more aggressive tumor biology requiring closer surveillance 2