This section has been reviewed and approved by the PLWC Editorial Board, 02/05

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 chronic disease.

Signs and symptoms

People with anemia may experience some of these symptoms:

  • Extreme tiredness or 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 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 blood-related complications.

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 start working.

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.

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