This section has been reviewed and approved by the PLWC Editorial
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 tiredness or fatigue associated with anemia can seriously
affect 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.
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.
Cancer and cancer treatment can cause anemia in the following ways:
- Some chemotherapy drugs
can cause the bone marrow to malfunction, 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 (such breast or lung cancers) can
crowd normal bone marrow cells.
- Chemotherapy drugs
containing platinum compounds (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 deficiency in the
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
Signs and symptoms
People with anemia may experience some of these symptoms:
- Extreme tiredness
- Muscle weakness
- Rapid or irregular heart
beat and occasional chest pain
- Difficulty breathing
or shortness of breath
- Dizziness or fainting
- Pallor (pale skin or
- Difficulty concentrating
- 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 the 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
If the anemia becomes symptomatic, a transfusion of RBCs
may be needed. Some people with anemia caused by chemotherapy can be
treated with the drugs 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
If anemia is caused by a nutritional deficiency, iron or folic acid pills
or vitamin B12 injections may be prescribed. 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.