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Side Effect Management - Anemia

Anemia is a condition in which the number of red blood cells (RBCs) in the blood is low.

Red blood cells contain hemoglobin, a protein that helps carry oxygen from the lungs to other parts of the body. When red blood cell levels are too low, the red blood cells can’t work properly. 

It is common for people with cancer to have anemia. Cancer treatments, such as chemotherapy and radiation therapy, as well as cancers that affect the bone marrow, can cause anemia.

Signs and symptoms of anemia

Anemia signs and symptoms vary among cancer patients and often go unnoticed at first. As the condition worsens, however, so do the symptoms, which may include:

  • Shortness of breath or difficulty breathing
  • Weakness or fatigue
  • Dizziness or lightheadedness
  • Headaches
  • Irregular heartbeats
  • Chest pain
  • Ringing in the ears
  • Cold hands and feet
  • Swelling in the hands and/or feet
  • Pale or yellowish skin

It’s important to monitor all unusual symptoms during your cancer treatment; be sure to talk with your doctor if you are having any of the symptoms listed above. Typically, your doctor will order blood tests during and after your cancer treatments. Often you’ll be tested for anemia during these times.

Causes of anemia

There are many causes of anemia in people with cancer, which can include:

  • The cancer itself
  • Radiation or chemotherapy
  • Blood loss
  • Certain vitamins or minerals missing in your diet, especially iron
  • Low iron levels in your blood
  • Major organ problems, including severe heart, lung, kidney, or liver disease

Ways to manage anemia

Since red blood cells are destroyed as a side effect of chemotherapy/radiation therapy, there is nothing specifically that you can do to prevent anemia from occurring. Anemia usually causes you to feel weak and tired; therefore, it is very important that when you are anemic you try to prevent your body from becoming extremely tired. Failure to do so may result in illness. Here are some steps you can take if you have fatigue caused by anemia:

1. Save your energy and ask for help.

  • Get plenty of sleep.
  • Avoid prolonged or strenuous activity.
  • Pace yourself. Take rest periods during activities that make you feel tired. If necessary, take short naps throughout the day.
  • Prioritize your activities so you will have enough energy for important activities or the activities that you enjoy the most.
  • Ask friends and family to help you prepare meals or do chores when you are tired.

2. Balance rest with activity.

  •  Take short naps during the day. Keep in mind that too much bed rest can make you feel weak.
  • If you are able, take short walks or exercise a little every day.

3. Eat and drink well.

  • Eat foods high in iron, including dark leafy greens, sweet potatoes, beans, meat and fish, prunes and raisins, dried apricots and peaches, and enriched bread, cereal, and pasta. Only eat a diet rich in iron if instructed by your provider, anemia can be chemo induced. 
  • Drink plenty of non-alcoholic fluids.
  • Avoid caffeine and big meals late in the day if you're having trouble sleeping at night.
  • Take iron supplements only if your oncologist or nurse practitioner/physician assistant has told you to do so.

When to see a doctor

If you are anemic, call your doctor immediately if you have any one or more of the following:

  • Dizziness
  • Shortness of breath or difficulty breathing
  • Excessive weakness or fatigue
  • Palpitations or chest pain

Prepare for your visit by making a list of questions to ask. Consider adding these questions to your list:

  • What is causing the anemia?
  • What problems should I call you about?
  • What steps can I take to feel better?
  • Would medicine, iron pills, a blood transfusion, or other treatments help me?
  • Would you give me the name of a registered dietitian who could also give me advice?

How is anemia treated?

Addressing the cause of anemia and raising the hemoglobin levels in the blood so that symptoms improve are the two main goals in treating anemia. Depending on the cause and severity of the anemia, there are several ways that anemia can be treated. Your doctor may:

  • Instruct you to eat iron-rich foods, such as dark leafy greens, sweet potatoes, beans, meat and fish, prunes and raisins, dried apricots and peaches, and enriched bread, cereal, and pasta
  • Recommend over-the-counter iron pills
  • Order blood transfusions
  • Order injections of a growth factor (e.g., Aranesp or Procrit), which are substances that work to stimulate the bone marrow to make more blood cells

 

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