Important contributing factors include iron deficiency secondary to bleeding or nutritional deficiencies [6], hemolysis due to immune phenomena, activation of clotting cascades or abnormal tumor-associated vasculature [7], impaired erythropoiesis secondary to inadequate erythropoietin production or depressed response of the erythroid marrow to erythropoietin [8], and direct invasion of the marrow by tumor cells with disruption of the erythropoietic environment. Here, EPO is linked to neoplasm.