Anemia

A shortage of red blood cells is called anemia.  This causes depletion of hemoglobin, the part of the red blood cell used to transport oxygen to body tissues.  This may cause fatigue and weakness, among many other symptoms.

 

Other common symptoms of anemia:

• Shortness of breath
• Faster heart beat
• Cold feeling of body
• Dizziness
• Swelling in hands and/or feet
• Pale skin
• Pain in chest

During cancer treatment patients should have their hemoglobin level measured regularly.  If levels are too low, it may be better for treatment to be discontinued until hemoglobin levels are back to normal.  Cancer patients are considered anemic when hemoglobin levels reach 10.0 gm/dL.

 

Who is affected by anemia?

Chemotherapy patients who receive platinum-based drugs are more likely to experience anemia.  Cisplatin (Platinol) and carboplatin (Paraplatin) are the most common platinum-based drugs.  Anemia may also occur when radiation therapy is focused upon certain bones that are rich in bone marrow.  Some common bones that are rich in bone marrow are the pelvis and sternum.  Surgery that causes severe bleeding may also cause anemia.

 

Why does do patients experience anemia?

Red blood cells are especially susceptible to damage from chemotherapy and radiation therapy, because of their rapid division and growth rate.   Bone marrow is where new red blood cells are created.  Therefore, disruption in bone marrow processes due to treatment can be a major factor in anemia.  Platinum-based chemotherapy drugs damages kidney tissues that help produce the hormone erythropoietin.  This hormone plays a role in the growth of red blood cells.  Blood loss from surgery causes anemia if the body cannot replace the red blood cells fast enough.

 

When do patients experience anemia?

After surgery anemia may occur within hours or days of the surgery.  Anemia can occur at anytime during chemotherapy or radiation therapy.  The side effect usually subsides 1 to 2 weeks after completion of treatment.

 

Managing Anemia

Anemia management attempts to increase hemoglobin in order to alleviate symptoms.  There are several ways to stimulate red blood cell growth, including iron and folic acid intake, blood transfusions, and growth factors, which are drugs that stimulate new red blood cells.  These methods may also help alleviate fatigue.

There are many methods for increasing iron, which may help reverse anemia.  Patients may eat foods high in iron, such as leafy green vegetables, dried fruit, seafood, beef, chicken, eggs and nuts.  Physicans may recommend iron supplements, which are available over-the-counter.

When hemoglobin is low, blood transfusions may rapidly increase needed iron.  Usually levels below 8g/dL require a blood transfusion, however the attending physician will decide what level is appropriate for each individual patient.  Patients should be aware of some inherent risks of this treatment.  Transfusion reaction is the most common risk, but is usually minor. However it can become serious.  Although there is risk of infection from hepatitis B or human immunodeficiency virus (HIV), developments in screen procedures make infection uncommon.

Another method of inducing red blood cell production is using drugs called red blood cell growth factors.  However, growth factors work much slower than blood transfusions.  It usually takes at least 2 weeks before they take effect.  Some common red blood cell factors are epoetin (Epogen or Procrit) and darbepoetin (Arenesp).

 

When should patients discuss anemia with their physician?

Patients should ask their physicians about the risk of anemia when discussing treatment options.  It is important for patients to know about the likelihood of anemia if a doctor prescribes chemotherapy.  Patients should also ask about the risk of anemia cause by bleeding when planning for a surgical procedure.  Physicians should give suggestions on how to conserve energy. However, if patients still feel extreme fatigue or experience other signs of anemia, then they should contact their doctor.