Evaluation of Red Blood Cell Biomechanics in the Setting of Cancer‐Associated Anemia and Chemotherapy

INTRODUCTION: Red blood cells (RBCs) possess distinct biomechanical properties that enable their survival and efficient oxygen delivery. Cancer-associated anemia, frequently compounded by chemotherapy, is a major clinical challenge, yet little is known about how RBC biomechanics contribute to its pathophysiology. This study evaluates the biomechanical properties of RBCs in patients with cancer compared to controls and within patients before and after chemotherapy. METHODS: Biomechanical properties of RBCs were assessed in 110 women with breast, ovarian, or endometrial cancer, measured before and after chemotherapy, and compared findings with 35 healthy female controls. Thirteen biomechanical parameters were assessed using the MIZAR automated rheometer. RESULTS: Relative to controls, pre-chemotherapy cancer patients exhibited significantly higher RBC aggregation and elasticity. Within the cancer cohort, anemic patients demonstrated more deformable and elastic RBCs, with increased aggregation compared to non-anemic patients. Following chemotherapy, patients displayed reduced RBC deformability but further increased elasticity, consistent with chemotherapy-induced alterations to membrane structure and function; these effects were most pronounced in anemic patients. CONCLUSION: We report novel rheological observations indicating that both cancer and chemotherapy are associated with alterations in RBC biomechanics, and that anemia further amplifies these changes. Importantly, cancer-associated anemia appears to involve impaired RBC quality. Recognition of biomechanical dysfunction may provide new insights into the mechanisms of cancer-related anemia and support the development of more comprehensive diagnostic and management strategies.