Table of ContentsView AllTable of ContentsOverviewSymptomsCausesDiagnosisTreatmentCopingSummary
Table of ContentsView All
View All
Table of Contents
Overview
Symptoms
Causes
Diagnosis
Treatment
Coping
Summary
Chemo-induced anemia isn’t something we hear about as often as, say,hair loss, but it is a very common and undertreated side effect of chemotherapy. Anemia can result in fatigue and lightheadedness as well as other symptoms, but fortunately, it is relatively easy to diagnose with a complete blood count.
When severe, treatment options can include blood transfusions, iron supplements, or medications to stimulate blood cell production.That said, anemia related to chemotherapy can often be managed with conservative measures to cope with the symptoms.
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Also known as “low blood” or “iron-poor blood,” anemia is defined as a decrease in the number of red blood cells (RBC) orhemoglobin. This results in a diminished ability of the blood to carry oxygen to body tissues.
Anemia is usually defined as a hemoglobin less than 13.5 grams/100 ml in men and less than 12 grams/100 ml in women.
Incidence
Anemia during chemotherapy is extremely common, with one study finding that 89.5% of people with solid tumors receiving chemotherapy experienced some degree of anemia. Thankfully, the vast majority of these people suffered only mild to moderate anemia.
Impact
In addition to the obvious fact that anemia can worsen the fatigue that is already common with cancer, anemia can negatively impact cancer treatment in other ways. It’s been found that moderate or severe anemia due to chemotherapy can result in delay of subsequent chemotherapy sessions or the need to reduce the dose (which may, in turn, result in lower effectiveness).
Symptoms you may experience with chemo-induced anemia, as well as anemia not related to cancer, include the following:
There are several causes of anemia during cancer treatment, including:
Your healthcare provider will order a complete blood count (CBC) before and after chemotherapy to assess your red blood cell count as well as hemoglobin. A CBC also includes information (called red blood cell indices) about the red blood cells in your blood, such as the size (MCV), amount of hemoglobin (MCHC), and variety of sizes (RDW). These tests can help further define your anemia.
It’s important to note that there are many types of anemia and many causes in addition to chemotherapy. Sometimes further testing is needed to evaluate the precise causes. For example, a combined anemia (such as the combination of chemotherapy-related bone marrow suppression plus vitamin B12 deficiency) may not be obvious from a complete blood count alone. Further testing may include:
At other times, especially if your red blood cell count is very low or you are experiencing symptoms, your healthcare provider may recommend treatment. Options for treatment include:
Transfusions
The fastest way to increase red blood cells is with a blood transfusion. Side effects can include fever, chills, and the small risk of having ablood transfusion reactionor contracting an infectious disease, such as hepatitis.
Iron Supplements
Oral or IV iron supplements might be recommended. Iron taken orally is the easiest but can cause stomach discomfort. Common side effects of intravenous iron are a transient feeling of flushing, a metallic taste, headaches, and joint or muscle aches a few days after treatment. Occasionally, iron injections can cause allergic reactions that can be serious.
Medications to Stimulate Formation of Red Blood Cells
Medications are sometimes used (often along with intravenous iron) to stimulate the production of red blood cells in your body.There is currently a lot of controversy about this treatment and your oncologist will discuss the benefits and possible risks if this is recommended. These medications includeProcrit or Epogen (epoetin alfa) and Aranesp (Darbepoetin alfa).
The best way to cope with anemia is to allow yourself to take it easier than usual until your body is able to catch up and make more red blood cells. The good news is that anemia is one cause of fatigue that is very treatable and it will usually begin to improve a few weeks after completing chemotherapy.
While you are anemic, try to:
For loved ones, understand that people with anemia during chemotherapy may hesitate to ask for help for fear of being a burden or losing their independence. Be prepared to assist even when they fail to ask.
When to Call the Healthcare Provider
Let your healthcare provider know if you are experiencing any symptoms that may be due to anemia. Between visits, call if you notice any of these symptoms worsening, especially if you become more short of breath, your heart rate is more rapid than usual, you feel fatigued despite rest, or if you feel lightheaded or disoriented.
Resting, drinking plenty of water, and rising slowly to avoid dizziness can help you manage symptoms. While often mild, chemo-induced anemia should be monitored for worsening symptoms, such as increased fatigue, and discussed with a healthcare provider.
13 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.American Society of Hematology.Anemia.American Society of Hematology.Anemia.Xu H, Xu, Page JH, et al.Incidence of anemia in patients diagnosed with solid tumors receiving chemotherapy, 2010-2013.Clinical Epidemiology. 8:61-71.doi: 10.2147/CLEP.S89480Family L, Xu L, Xu H, et al.The effect of chemotherapy-induced anemia on dose reduction and dose delay.Supportive Care in Cancer. 24(10):4263-71. doi:10.1007/s00520-016-3258-3MedlinePlus.Anemia. Updated January 19, 2018.American Cancer Society.Anemia in people with cancer.Deak AT, Troppan K, Rosenkranz AR.Anemia management in cancer patients with chronic kidney disease.Eur J Intern Med. 2016;36:13-19. doi:10.1016/j.ejim.2016.08.036American Association for Clinical Chemistry.Blood smear.Red Cross.Risks and complications.Arastu AH, Elstrott BK, Martens KL, Cohen JL, Oakes MH, Rub ZT, Aslan JJ, DeLoughery TG, Shatzel J.Analysis of Adverse Events and Intravenous Iron Infusion Formulations in Adults With and Without Prior Infusion Reactions. JAMA Netw Open. 2022 Mar 1;5(3):e224488. doi: 10.1001/jamanetworkopen.2022.4488. Erratum in: JAMA Netw Open. 2022 Jun 1;5(6):e2221567. doi: 10.1001/jamanetworkopen.2022.21567. PMID: 35353168; PMCID: PMC8968468.Rampton D, Folkersen J, Fishbane S, Hedenus M, Howaldt S, Locatelli F, Patni S, Szebeni J, Weiss G.Hypersensitivity reactions to intravenous iron: guidance for risk minimization and management. Haematologica. 2014 Nov;99(11):1671-6. doi: 10.3324/haematol.2014.111492. PMID: 25420283; PMCID: PMC4222472.U.S. Food and Drug Administration.Information on erythropoiesis-stimulating agents (ESA) Epoetin alfa (marketed as Procrit, Epogen), Darbepoetin alfa (marketed as Aranesp).Canadian Cancer Society.Low Blood Cell Counts.Additional ReadingMhaskar R, Wao J, Miladinovic B, Kumar A, Djulbegovic B.The role of iron in the management of chemotherapy-induced anemia in cancer patients receiving erythropoiesis-stimulating agents.Cochrane Database of Systematic Reviews. 2016. 2:CD009624. doi: 10.1002/14651858.CD009624.pub2
13 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.American Society of Hematology.Anemia.American Society of Hematology.Anemia.Xu H, Xu, Page JH, et al.Incidence of anemia in patients diagnosed with solid tumors receiving chemotherapy, 2010-2013.Clinical Epidemiology. 8:61-71.doi: 10.2147/CLEP.S89480Family L, Xu L, Xu H, et al.The effect of chemotherapy-induced anemia on dose reduction and dose delay.Supportive Care in Cancer. 24(10):4263-71. doi:10.1007/s00520-016-3258-3MedlinePlus.Anemia. Updated January 19, 2018.American Cancer Society.Anemia in people with cancer.Deak AT, Troppan K, Rosenkranz AR.Anemia management in cancer patients with chronic kidney disease.Eur J Intern Med. 2016;36:13-19. doi:10.1016/j.ejim.2016.08.036American Association for Clinical Chemistry.Blood smear.Red Cross.Risks and complications.Arastu AH, Elstrott BK, Martens KL, Cohen JL, Oakes MH, Rub ZT, Aslan JJ, DeLoughery TG, Shatzel J.Analysis of Adverse Events and Intravenous Iron Infusion Formulations in Adults With and Without Prior Infusion Reactions. JAMA Netw Open. 2022 Mar 1;5(3):e224488. doi: 10.1001/jamanetworkopen.2022.4488. Erratum in: JAMA Netw Open. 2022 Jun 1;5(6):e2221567. doi: 10.1001/jamanetworkopen.2022.21567. PMID: 35353168; PMCID: PMC8968468.Rampton D, Folkersen J, Fishbane S, Hedenus M, Howaldt S, Locatelli F, Patni S, Szebeni J, Weiss G.Hypersensitivity reactions to intravenous iron: guidance for risk minimization and management. Haematologica. 2014 Nov;99(11):1671-6. doi: 10.3324/haematol.2014.111492. PMID: 25420283; PMCID: PMC4222472.U.S. Food and Drug Administration.Information on erythropoiesis-stimulating agents (ESA) Epoetin alfa (marketed as Procrit, Epogen), Darbepoetin alfa (marketed as Aranesp).Canadian Cancer Society.Low Blood Cell Counts.Additional ReadingMhaskar R, Wao J, Miladinovic B, Kumar A, Djulbegovic B.The role of iron in the management of chemotherapy-induced anemia in cancer patients receiving erythropoiesis-stimulating agents.Cochrane Database of Systematic Reviews. 2016. 2:CD009624. doi: 10.1002/14651858.CD009624.pub2
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
American Society of Hematology.Anemia.American Society of Hematology.Anemia.Xu H, Xu, Page JH, et al.Incidence of anemia in patients diagnosed with solid tumors receiving chemotherapy, 2010-2013.Clinical Epidemiology. 8:61-71.doi: 10.2147/CLEP.S89480Family L, Xu L, Xu H, et al.The effect of chemotherapy-induced anemia on dose reduction and dose delay.Supportive Care in Cancer. 24(10):4263-71. doi:10.1007/s00520-016-3258-3MedlinePlus.Anemia. Updated January 19, 2018.American Cancer Society.Anemia in people with cancer.Deak AT, Troppan K, Rosenkranz AR.Anemia management in cancer patients with chronic kidney disease.Eur J Intern Med. 2016;36:13-19. doi:10.1016/j.ejim.2016.08.036American Association for Clinical Chemistry.Blood smear.Red Cross.Risks and complications.Arastu AH, Elstrott BK, Martens KL, Cohen JL, Oakes MH, Rub ZT, Aslan JJ, DeLoughery TG, Shatzel J.Analysis of Adverse Events and Intravenous Iron Infusion Formulations in Adults With and Without Prior Infusion Reactions. JAMA Netw Open. 2022 Mar 1;5(3):e224488. doi: 10.1001/jamanetworkopen.2022.4488. Erratum in: JAMA Netw Open. 2022 Jun 1;5(6):e2221567. doi: 10.1001/jamanetworkopen.2022.21567. PMID: 35353168; PMCID: PMC8968468.Rampton D, Folkersen J, Fishbane S, Hedenus M, Howaldt S, Locatelli F, Patni S, Szebeni J, Weiss G.Hypersensitivity reactions to intravenous iron: guidance for risk minimization and management. Haematologica. 2014 Nov;99(11):1671-6. doi: 10.3324/haematol.2014.111492. PMID: 25420283; PMCID: PMC4222472.U.S. Food and Drug Administration.Information on erythropoiesis-stimulating agents (ESA) Epoetin alfa (marketed as Procrit, Epogen), Darbepoetin alfa (marketed as Aranesp).Canadian Cancer Society.Low Blood Cell Counts.
American Society of Hematology.Anemia.
Xu H, Xu, Page JH, et al.Incidence of anemia in patients diagnosed with solid tumors receiving chemotherapy, 2010-2013.Clinical Epidemiology. 8:61-71.doi: 10.2147/CLEP.S89480
Family L, Xu L, Xu H, et al.The effect of chemotherapy-induced anemia on dose reduction and dose delay.Supportive Care in Cancer. 24(10):4263-71. doi:10.1007/s00520-016-3258-3
MedlinePlus.Anemia. Updated January 19, 2018.
American Cancer Society.Anemia in people with cancer.
Deak AT, Troppan K, Rosenkranz AR.Anemia management in cancer patients with chronic kidney disease.Eur J Intern Med. 2016;36:13-19. doi:10.1016/j.ejim.2016.08.036
American Association for Clinical Chemistry.Blood smear.
Red Cross.Risks and complications.
Arastu AH, Elstrott BK, Martens KL, Cohen JL, Oakes MH, Rub ZT, Aslan JJ, DeLoughery TG, Shatzel J.Analysis of Adverse Events and Intravenous Iron Infusion Formulations in Adults With and Without Prior Infusion Reactions. JAMA Netw Open. 2022 Mar 1;5(3):e224488. doi: 10.1001/jamanetworkopen.2022.4488. Erratum in: JAMA Netw Open. 2022 Jun 1;5(6):e2221567. doi: 10.1001/jamanetworkopen.2022.21567. PMID: 35353168; PMCID: PMC8968468.
Rampton D, Folkersen J, Fishbane S, Hedenus M, Howaldt S, Locatelli F, Patni S, Szebeni J, Weiss G.Hypersensitivity reactions to intravenous iron: guidance for risk minimization and management. Haematologica. 2014 Nov;99(11):1671-6. doi: 10.3324/haematol.2014.111492. PMID: 25420283; PMCID: PMC4222472.
U.S. Food and Drug Administration.Information on erythropoiesis-stimulating agents (ESA) Epoetin alfa (marketed as Procrit, Epogen), Darbepoetin alfa (marketed as Aranesp).
Canadian Cancer Society.Low Blood Cell Counts.
Mhaskar R, Wao J, Miladinovic B, Kumar A, Djulbegovic B.The role of iron in the management of chemotherapy-induced anemia in cancer patients receiving erythropoiesis-stimulating agents.Cochrane Database of Systematic Reviews. 2016. 2:CD009624. doi: 10.1002/14651858.CD009624.pub2
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