Kurdistan Regional Government

Paitxt private technical institute

Department of pharmacy

Effects of Cancer and Chemotherapy on Some Biochemical and

Hematological Parameters

A Study

Submitted to the Department of Pharmacy,

Paitaxt Private Technical Institute

As a Partial Fulfillment of the Requirements for the Diploma Degree

By

Mahmud yasin , bawan nawzad, ahmad adham, muhamad kaka, ali taib &
omer ibrahim

Supervised by

Dr. muslih s.hamasharif

May- 2020 Gulan-2720

2
Dedication

To…

 Warmhearted father and mother.

 To all whom I love.

Mahmud,bawan,ahmad,muhamad,ali,omer

Acknowledgements
I
 Thanks God, the most merciful and compassionate, for giving us the strength
and guidance we needed to face today and not worry about tomorrow.

First and foremost, we would like to express the utmost gratitude to our
supervisor Dr. muslih h.hamasharif for his time, support, wisdom, patience,
understanding, generous and valuable assistance in the preparation and completion
of this research. Through him, we think we have learned a lot and accomplished
more than ever possible.

Abstract

II
 The objective of the present study is to investigate the effects of cancer and
chemotherapy on some hematological and biochemical parameters in cancer
patients. In this study thirty cancer cases and thirty healthy cases which putted as
cancer and normal groups were taken. The blood was collected for determination
of some hematological and biochemical parameters. The results showed that red
blood cells (RBCs) and hemoglobin (Hb) concentration significantly decreased in
cancer group as compared to normal group. In contrast, the value of glutamic
oxaloacetic transaminase (GOT), glutamic pyruvic transaminase (GPT), creatinine
and urea significantly increased in cancer group as compared to normal group. In
conclusion: cancer and chemotherapy treatment have a negative impact on liver
and kidney functions.

Keywords: Cancer, chemotherapy, kidney function parameters, liver function

parameters, some hematological parameters.

III
 List of Abbreviations

Abbreviations Definition

WBCs White blood cells

RBCs Red blood cells

PLTs Platelets

MPV Mean platelet volume

HCT Hematocrit

Hb Hemoglobin

Glutamic oxaloacetic transaminase

GOT

Glutamic pyruvic transaminase

GPT

IV
 CONTENTS

Title Pages

Dedication I
Acknowledgements II
Abstract III
Abbreviations IV
Contents V
CHAPTER ONE
1. Introduction 1-3
CHAPTER TWO
2. Materials and methods 4
2.1. Experimental design 4
2.2. Data collection 4
2.3 Determination of creatinine, urea, GOT, GPT, RBCs, Hb, HCT, WBC, 4
PLTs, MPV and glucose
2.4. Statistical analysis 4

CHAPTER THREE
3. Results 5-15
3.1. Creatinine level 5
3.2. Urea level 6
3.3. GOT activity 7
3.4. GPT activity 8
3.5. RBCs number 9
3.6. Hb level 10
3.7. HCT level 11
3.8. WBCs number 12
3.9. PLTs number and MPV value 13-14
3.10. Glucose level 15

V
 CHAPTER FOUR
4. Discussion 16-17
4.1. Creatinine and urea 16
4.2. GOT and GPT 17
4.3. RBCs and Hb 17
Conclusions 18
Recommendation 18
References 19-21

VI
 List of Figures

NO Title Pages
1 Figure 1: The effect of cancer and chemotherapy on creatinine 5
level.
2 Figure 2: The effect of cancer and chemotherapy on urea level. 6
3 Figure 3: The effect of cancer and chemotherapy on GOT activity. 7
4 Figure 4: The effect of cancer and chemotherapy on GPT activity. 8
5 Figure 5: The effect of cancer and chemotherapy on RBCs 9
number.
6 Figure 6: The effect of cancer and chemotherapy on Hb level. 10
7 Figure 7: The effect of cancer and chemotherapy on HCT level. 11
8 Figure 8: The effect of cancer and chemotherapy on WBCs 12
number.
9 Figure 9: The effect of cancer and chemotherapy on PLTs 13
number.
10 Figure 10: The effect of cancer and chemotherapy on MPV value. 14
11 Figure 11: The effect of cancer and chemotherapy on glucose 15
level.

VII
 1. Introduction

Cancer is an abnormal growth of cells, in which the cells have lost normal control
mechanisms and are able to multiply continuously, invade nearby tissues, migrate to
distant parts of the body, and promote the growth of new blood vessels from which the
cells derive nutrients. The cancerous malignant cells can develop from any tissue within
the body (Gale et al., 2018). The classification of various types of tumor very important
in cancer diagnosis and drug discovery. Several previous cancer classification studies are
clinical based and have limited diagnostic ability (Lu et al., 2003). Some types of cancer
cause rapid cell growth, while others cause cells to grow and divide at a slower rate (Nall,
2020). Sex, age, race, genetic predisposition, and exposure to environmental carcinogens
are factors which concerning to cancer types. Also, exposure to ionizing radiation has
been well documented as a significant risk factor for a number of cancers (Chu et al.,
1974). Cancer is the first leading cause of death in economically developed countries and
the second leading cause of death in developing countries (Jemal et al., 2011).

Chemotherapy is one of the main therapeutic methods use against cancer. Commonly
the organic compounds or natural products like alkylating agents, antibiotics, alkaloids,
enzymes and hormones were major antitumor drugs since long time ago. But inorganic
compounds, especially metal-containing compounds, were not systematically
investigated since most metals were considered to be potential carcinogens (Haiduc et al.,
1990). In addition, natural products have been the mainstay of cancer chemotherapy for
the past 30 years. However, the quickening pace of aberrant gene identification, and the
new technologies of combinatorial chemistry and high-throughput screening, should
provide access to a wide range of new, totally synthetic drugs (Mann et al., 2002).
Furthermore, development of chemoresistance is a persistent problem during the
treatment of local and disseminated disease. A plethora of cytotoxic drugs that
selectively, but not exclusively, target actively proliferating cells include such diverse

1
groups as DNA alkylating agents, antimetabolites, intercalating agents and mitotic
inhibitors (Luqmani et al., 2005). The main chemotherapy physical side-effects are
vomiting, nausea and hair loss (Coates et al., 1983). Also, anticancer chemotherapies are
responsible for numerous adverse events, hematological toxicity is one of the main
causes for ending treatment, because these toxicities decrease the production of RBCs,
white blood cells (WBCs) and platelets (PLTs), which may be life-threatening to the
patient (Paillet et al., 2007).

The administration of chemotherapy is a challenge for the tight regulation and balance
of metabolism of nutrients (proteins, glucose and fatty acids), for the clearance of toxic or
infectious agents, for metabolic detoxification and for the excretion of waste products
processes. As most drugs tend to be lipophilic, they are readily taken up by the liver.
Under chemotherapy treatment, up to 85% of patients develop liver steatosis (Ramdori et
al., 2010). The liver has a crucial role in the metabolism of many commonly used
anticancer agents, cytotoxics or new biological agents. Due to the assessment of liver
function is a fundamental part of initial work-up and management of patients with cancer
(Field et al., 2008). In recent studies indicated effects of chemotherapy on some
biochemical and hematological parameters which is a cause for thrombosis in breast
cancer. The experiment was performed to determine whether the enhanced thrombosis
was due, in part, to an effect of chemotherapy on endothelial cell reactivity (Abdol Razak
et al., 2018). The acute kidney injury and electrolyte disturbances are the most common
forms of renal complications that may occur in a hospitalized cancer patient. On the other
hand, uric acid test is used to determine the rapid cell turnover as an effect of
chemotherapy. Generally, the mean value of uric acid level was higher than the normal
reference range before the start of chemotherapy courses (Chuhan et al., 2016).
Moreover, the number of WBCs declined in cancer patients resulting of bone marrow
damage which have a greater risk of infection (Herbst, 2017). It has been found that

2
complete blood count is a prerequisite investigation for cancer patients before the use of
any treatment (Akinbami et al., 2013).

3
 2. Materials and methods

2.1. Experimental design

This experiment was designed to study the effects of cancer and chemotherapy on
some biochemical and hematological parameters in cancer patients. In this study thirty
cancer cases and thirty healthy cases which divided as cancer and normal groups were
taken.

2.2. Sample collection

With the permissions required data of cancer patients after taken the chemotherapy
were collected from Nanakaly Hospital-Erbil, and the same data in healthy persons were
collected.

2.3. Determination of creatinine, urea, GOT, GPT, RBCs, Hb, HCT, WBC, PLTs,
MPV and glucose

2.4. Statistical analysis

All data were expressed as means + standard error (S.E) and statistical analysis was
carried out using GraphPad prism software (version 8.0.2) (Graph Pad Software, USA).

The comparisons between groups were done using parametric T test. P-values less
than 0.05 (P<0.05) were considered as statistically significant. In all figures the symbols,
(*, **, ***and ****) represent that mean of differences are significant at the 0.05, 0.01,
0.001and 0.0001 levels, respectively.

4
 3. Results
3.1. Creatinine level

Statistical analysis revealed that level of creatinine significantly (P<0.001) elevated in

cancer group (1.022 ± 0.04308mg/dl) as compared with normal group (0.7814 ± 0.03609
mg/dl) (Figure 1).

Figure 1: The effect of cancer and chemotherapy on creatinine level.

Each column with its vertical bar represent mean + SE.

5
3.2. Urea level

The concentration of blood urea significantly (P<0.01) increased in cancer group

(31.81 ± 1.564 mg/dl) as compared to control group (23.79 ± 2.000 mg/dl) (Figure 2).

Figure 2: The effect of cancer and chemotherapy on urea level.

Each column with its vertical bar represent mean + SE.

6
3.3. GOT activity

The data of the current study proved that activity of GOT significantly (P<0.05)
increased in cancer group (27.31 ± 1.893 U/L) as compared with normal group (22.60 ±
0.9778 U/L) (Figure 3).

Figure 3: The effect of cancer and chemotherapy on GOT

activity.

Each column with its vertical bar represent mean + SE.

7
3.4. GPT activity

Statistically it has been discovered that activity of GPT significantly (P<0.001)

increased in cancer group (26.21 ± 2.156 U/L) as compared with normal group (16.80
±0.9573 U/L) (Figure 4).

Figure 4: The effect of cancer and chemotherapy on GPT activity.

Each column with its vertical bar represent mean + SE.

8
 3.5. RBCs number

The data of current study showed that RBCs number significantly (P<0.05) decreased
in cancer group (4.542 ± 0.1188 *106/µL) as compared with normal group (4.917 ±
0.1096 *106/µL) (Figure 5).

gure 5:
effect of
cer and

chemotherapy on RBCs number.

Each column with its vertical bar represent mean + SE.

9
 3.6. Hb level

The study statistical analysis showed that Hb level significantly (P<0.05) decreased in
cancer group (12.30 ± 0.3976 g/dl) as compared with normal group (13.52 ±0.2806 g/dl)
(Figure 6).

ure 6: The
ffect of
ncer and
motherapy
Hb level.

Each column with its vertical bar represent mean + SE.

3.7. HCT level

The level of HCT non-significantly reduced in cancer group in comparison to control

group (Figure 7).

10
ure 7: The
ffect of
ncer and
motherapy
HCT level.

Each column with its vertical bar represent mean + SE.

3.8. WBCs number

11
 Statistical analysis revealed that the numbers of WBCs didn’t change significantly in
experimental groups group (Figure 8).

Figure 8: The effect of cancer and chemotherapy on WBCs number.

Each column with its vertical bar represent mean + SE.

3.9. PLTs number and MPV value

12
 In cancer and control groups the PLTs number and MPV value didn’t change
significantly (Figure 9) and (Figure 10).

Figure 9: The effect of cancer and chemotherapy on PLTs number.

Each column with its vertical bar represent mean + SE.

13
 Figure 10: The effect of cancer and chemotherapy on MPV value.

Each column with its vertical bar represent mean + SE.

3.10. Glucose level

14
 The statistical analysis showed that glucose level was not change in experimental
groups (Figure 11).

Figure 11: The effect of cancer and chemotherapy on glucose level.

Each column with its vertical bar represent mean + SE.

15
4. Discussion

4.1. Creatinine and urea

Results of the current study showed that creatinine and urea significantly increased in
cancer group as compared with normal group. Kidney disease heading towards becoming
a worldwide health problem (Narula, 2008), it’s a progressive decreasing in renal
function (Venktapathy et al., 2014). Creatinine and urea are good indicators for diagnoses
the status of renal function, as the kidneys can’t work properly tend to induce the
elevation of these measurements (Kamal, 2014). The obtained data was consistent with
the finding of Abdulla et al., (2012) that numerous health problem have negative effects
on kidneys function among them cancer and toxic chemicals lead to damage kidneys
structure then lose their functions. In addition, the kidney function parameters like
creatinine and urea determination are important in diagnosis and control the cancer
because cancer is the main cause to elevate the creatinine and urea concentration and
deterioration of renal functions (Faull, 2007). In other meaning the renal function
measurements like creatinine and urea are also important as diagnostic markers
implicated in the process of cancer development (Peterson et al., 2017).

4.2. GOT and GPT

Results of the present study showed that GOT and GPT activities significantly
increased in cancer group as compared with normal group. The liver has a crucial role in
the metabolism of many commonly used anticancer agents, cytotoxics or new biological
agents. Due to the assessment of liver function is a fundamental part of initial work-up
and management of patients with cancer (Field et al., 2008). The obtained data supported
by Ramdori et al., (2010), that liver steatosis develop in up to 85% of patients which
under taken chemotherapy treatment. Also, the liver has a crucial role in the metabolism
of many commonly used anticancer agents, cytotoxics or new biological agents. Due to

16
the assessment of liver function is a fundamental part of initial work-up and management
of patients with cancer (Field et al., 2008). Any deviation and negative effects on liver
lead to increases the activity of GOT and GPT enzymes.

4.3. RBCs and Hb

The data of the current study showed that RBCs number and Hb concentration
significantly decreased in cancer group as compared with normal group. The current
results are supported by the findings that cancer treatments affect the bone marrow’s
ability to make blood cells (Mozaffarian et al., 2003). Furthermore, it has been found that
anticancer chemotherapies significantly decrease the production of RBCs which may be
life-threatening to the patient (Paillet et al., 2007) the reduction in RBCs number directly
leads to decline the Hb concentration. In addition, chemotherapy medications and
radiation exposure can significantly reduce the levels of blood cells (Fine et al., 1997).

17
 Conclusions

From the data of the preset study the followings are concluded:

1. We improved that RBCs number and Hb are decreased in cancer patients and
chemotherapy treatment group.

2. We observed that cancer and chemotherapy treatment have negative effects on kidney
function parameters.

3. We discovered that cancer and chemotherapy treatment have negative effects on liver
function parameters.

Recommendations

-In the light of the results obtained from the current study, the followings can be
recommended:

1. Further researches are needed to explain the effect of cancer and chemotherapy on
other hematological and biochemical parameters.

2. Further studies are required to distinguish the effects of cancer and chemotherapy in
separate groups.

3. Additional studies are needed to investigate the risk of receiving cancer and
chemotherapy on different body system organs function.

18
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