Anemia is an abnormally low level of red blood cells (RBCs). RBCs contain hemoglobin, an iron protein that carries oxygen to all parts of the body. If the level of RBCs is too low, parts of the body do not get enough oxygen and cannot work properly. Most people with anemia feel tired or weak. The fatigue associated with anemia can seriously affect a person’s quality of life and make it more difficult for patients to cope with cancer and treatment side effects. Anemia is common in patients with cancer, especially in those receiving chemotherapy.

Causes

RBCs are made in the bone marrow (a spongy, fatty tissue found inside larger bones). A hormone called erythropoietin, made in the kidneys, tells the body when to make more RBCs. So, any damage to the kidney or bone marrow can cause anemia. For example:

• Some chemotherapy can cause the bone marrow to not work properly, impairing its ability to make enough RBCs.
  
  
• Cancers that affect the bone marrow directly (including leukemia or lymphoma) or cancers that metastasize (spread) to the bone can crowd normal bone marrow cells, including red blood cells.
  
  
• Platinum chemotherapy, such as cisplatin (Platinol) and carboplatin (Paraplatin) can injure the kidneys, lowering the production of erythropoietin.
  
  
• Radiation therapy to extensive areas of the body or to bones in the pelvis, legs, chest, or abdomen can damage the bone marrow.
  
  
• Nausea, vomiting, and loss of appetite can cause a lack of nutrients needed to make RBCs, including iron, vitamin B12, and folic acid.
  
  
• Bleeding, as a result of surgery, or a tumor causing internal bleeding can cause anemia if RBCs are lost faster than they can be replaced.
  
  
• The body’s immune system response to cancer cells can also cause anemia, called anemia of chronic disease.

Signs and symptoms

People with anemia may experience some of these symptoms:

• Fatigue
  
  
• Muscle weakness
  
  
• Rapid or irregular heart beat and occasional chest pain
  
  
• Difficulty breathing or shortness of breath
  
  
• Dizziness or fainting
  
  
• Pallor (pale skin or lips)
  
  
• Headaches
  
  
• Difficulty concentrating
  
  
• Insomnia
  
  
• Difficulty staying warm
  
  
• Bleeding problems

Diagnosis and treatment

Anemia is diagnosed with a blood test that counts the number or percentage of RBCs and measures the amount of hemoglobin in a person’s blood. People with certain types of cancer or those undergoing cancer treatment known to cause anemia, may have regular blood tests, usually a CBC (complete blood count), to look for anemia and other blood-related complications.

If the anemia causes symptoms, the person with cancer may need a transfusion of RBCs. Some people with anemia caused by chemotherapy can be treated with erythropoiesis-stimulating agents (ESAs) such as epoetin alfa (Epogen or Procrit) or darbepoetin alfa (Aranesp). These drugs are forms of erythropoietin that are grown in the laboratory and work by telling the bone marrow to make more RBCs. Both are given as a series of injections and can take up to four weeks to start working. Learn more about ASCO’s recommendations for epoetin treatment. People considering taking ESAs should be aware of revised product labeling for these medications, based on emerging safety data. Learn more about understanding ESAs.

Your doctor may prescribe iron or folic acids pills or vitamin B12 if they find that lack of these nutrients has contributed to your anemia. Eating foods high in iron (such as red meats, dried beans or fruits, almonds, broccoli, and enriched breads and cereals) or folic acid (such as enriched breads and cereals, asparagus, broccoli, spinach, and lima beans) may also help.

More Information

Bleeding and Clotting Problems

Managing Side Effects

Understanding Blood Test Results

Additional Resources

FDA: Questions and Answers about ESAs

Last Updated: June 30, 2009