Anemia is a reduction in the red blood cells (RBCs) or concentration of hemoglobin. Hemoglobin is part of the red blood cell that carries oxygen to all the cells in the body. When the red blood cell count or hemoglobin level is low, body tissues don’t get enough oxygen to do their jobs properly.
The normal value for:
- red blood cell levels vary for males and females and from laboratory to laboratory
- male: 4.6–6.2 x 1012 /L
- female: 4.2–5.4 x 1012 /L
- hemoglobin ranges from 120–160 g/L
A person has anemia when their hemoglobin falls to about 100 g/L or less. Some people may have symptoms of anemia when hemoglobin is higher or lower than this level.
Causes
Anemia can be caused by:
- iron, vitamin B12, and/or folic acid deficiency
- blood loss due to excessive bleeding
- some chronic diseases, such as kidney disease
- excessive destruction of red blood cells due to certain diseases or immune system reactions to blood cells
- decreased red blood cell production caused by bone marrow involvement with cancer or cancer treatments, such as chemotherapy or radiation therapy
Symptoms
Anemia tends to develop slowly in people receiving cancer treatments. A variety of symptoms can occur as a result of decreased oxygen getting to the body tissues or the body's response to it. Some of the symptoms of anemia are:
- fatigue
- lack of energy
- malaise
- paleness of skin and nails
- dizziness
- shortness of breath
- increased heart rate
- low blood pressure
- chest pain or feeling that the heart is skipping a beat (palpitations)
- feeling cold or chilled
- headache
Diagnosis
Anemia is usually diagnosed by:
- taking a history of symptoms, medications, treatments and doing a physical examination
- doing blood tests to check the level of red blood cells, hemoglobin, iron and vitamin B12
- sometimes a bone marrow aspiration and biopsy will be done to find out the underlying cause (if not already known)
Management
Treatment is given once the cause of anemia is identified, especially if the person has symptoms such as fatigue or shortness of breath. There are several measures that can be used to help cope with anemia:
- Avoid prolonged or strenuous activity.
- Get plenty of rest to keep up energy levels.
- Schedule rest breaks throughout the day.
- Move slowly to avoid getting dizzy and when getting out of bed, sit on the side of the bed for awhile before standing up.
- Try limiting activities to those that are most important.
- Eat a balanced diet that includes foods high in iron such as green leafy vegetables, liver and cooked red meats.
Oral supplements
Medications may be used to help correct underlying iron, vitamin B12, and/or folic acid deficiencies. Take iron pills or other medications if prescribed by the doctor.
Blood transfusions
Blood transfusions may be needed to provide relief of symptoms, such as shortness of breath, until the bone marrow is able to replace RBCs. If the cause of anemia is not corrected with a single transfusion of red blood cells, then repeated blood transfusions may be required.
Colony-stimulating factors
The healthcare team may recommend a special drug to help red blood cell counts return to normal levels. Growth factors (colony-stimulating factor or CSF) may be given to stimulate the bone marrow to produce red blood cells.
Erythropoietin is a hormone made by the kidney that is involved in making red blood cells. Drugs such as epoetin (Eprex, erythropoietin) or darbepoetin (Aranesp) are erythropoietin products that may be used in some people with anemia. These drugs may decrease the need for blood transfusions and have been shown to improve the quality of life in many people with anemia related to cancer. They are given by subcutaneous injection, 1–3 times a week for epoetin and once a week or every other week for darbepoetin.
These drugs will not give the same fast result as a blood transfusion, but the response they give may last longer. It may take anywhere from 2–8 or more weeks of treatment for the person to benefit from this therapy.
This treatment may not work for all people with cancer that have anemia.