Effect of Chemotherapy on Hematological and Coagulation Parameters among Women with Breast Cancer at the National Cancer Institute-Sudan

Abstract

Background: Breast cancer, which accounts for around 34% of all female cancers, is a major global health concern with a considerable prevalence in Sudan. By investigating the impact of sociodemographic characteristics and lifestyle decisions on the development of breast cancer in Sudanese women, this study seeks to close the knowledge gap. This study targeted breast cancer patients and changes during coarse of chemotherapy in some of hematological parameters, such as hemoglobin, white blood cell, platelet count and coagulation profile in order to focus on what phase changes occurred, the study conducted at the National Cancer Institute (NCI) in Gezira state. Method: the study recruited 70 females with breast cancer, new cases, under chemotherapy with different number of doses. Healthy subjects well used as control group for comparisons, blood samples collected used for complete blood count assessment and prothrombin time (PT) and activated partial thromboplastin time (APTT) as n INR. Data collected analyzed via statistical package of social science (SPSS) version 20. Result: Considering the affection of chemotherapy dose used by patients, measured parameters, it revealed that there were significant differences in mean+SD of parameters PT, APTT, INR, and Hb as p value for each <0.05 and the rest showed no significant p value >0.05. Comparison of measured parameters mean+SD before and after chemotherapy doses showed that there was no significant difference between pre chemotherapy patients and post chemotherapy patients in Hb, TWBCs, Platelet, PT, APTT and INR.

Introduction

This study examines the effects of breast cancer and chemotherapy on hematological and coagulation parameters in breast cancer patients. Breast cancer is the most common cancer among women worldwide and a leading cause of cancer-related deaths. Disease stage at diagnosis strongly influences survival, and factors such as age, family history, reproductive history, and comorbidities affect both the risk and prognosis of breast cancer. Although breast cancer incidence is higher in high-income countries, mortality rates are greater in low-income regions due to limited healthcare resources.

Chemotherapy remains a major treatment option and is classified into neoadjuvant, adjuvant, and salvage chemotherapy. It helps reduce recurrence, eliminate microscopic cancer cells, and shrink tumors before surgery. However, chemotherapy can also affect blood cell production and coagulation by damaging bone marrow cells and interfering with DNA replication. These effects may lead to anemia, altered white blood cell counts, platelet abnormalities, and changes in blood clotting.

Materials and Methods

A case-control study was conducted at the National Cancer Institute in Gezira State between June and September 2021. The study included:

• 70 female breast cancer patients
  • 10 newly diagnosed patients
  • 50 patients receiving fewer than 10 chemotherapy doses
  • 10 patients receiving more than 10 chemotherapy doses
• 50 healthy women as controls

Blood samples were analyzed for:

• Hemoglobin (Hb)
• Total white blood cells (TWBCs)
• Platelet count
• Prothrombin Time (PT)
• Activated Partial Thromboplastin Time (APTT)
• International Normalized Ratio (INR)

Statistical analysis was performed using SPSS.

Key Findings

Comparison Between Patients and Controls

Compared with healthy controls, breast cancer patients showed:

• Significantly lower hemoglobin levels (anemia)
• Significantly lower PT
• Significantly higher white blood cell counts
• Significantly higher platelet counts
• No significant differences in APTT or INR

Blood Abnormalities Among Patients

Among the 70 breast cancer patients:

• 67.1% had anemia
• 22.9% had leukopenia
• 18.6% had leukocytosis
• 40% had thrombocytosis
• 8.6% had thrombocytopenia

Effect of Chemotherapy

No significant differences were observed between pre-chemotherapy and post-chemotherapy groups overall. However, when chemotherapy dose was considered:

• Higher chemotherapy doses were associated with significant increases in PT, APTT, and INR
• Higher doses were associated with a significant decrease in hemoglobin levels
• White blood cell and platelet counts were not significantly affected by dose

Effect of Disease Duration

Patients with breast cancer for more than 12 months showed:

• Higher PT and INR
• Lower hemoglobin levels
• No significant differences in APTT, white blood cells, or platelets

Effect of Age

No significant differences in hematological or coagulation parameters were found between patients aged 50 years or younger and those older than 50 years.

Conclusion

There was a significant alteration in hematological parameters and coagulation parameters (PT test) and this alteration of hematological and coagulation parameters increased according to number of dose and duration of disease in breast cancer women.

References

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Copyright

Copyright © 2026 Hoyam Awad M. Bashir , Elharam Ibrahim, Babeker A. Ahmed , Ines Belaiba Aloulou, Hutheiefa Ibrahim Y. Mohammed. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.