Why Cancer Patients Become Anemic

by Jane Ashley

What causes anemia in cancer patients? How can we fix it? Nothing is more frustrating than being told that we can’t have chemo or learn that our surgery has been postponed we are anemia.


What is anemia? 

Anemia is a common blood disorder. It occurs when we don’t have enough healthy red blood cells. Red blood cells are produced in our bone marrow, and they transport hemoglobin. The hemoglobin picks up oxygen in the lungs and delivers it throughout our body.

If our iron levels fall or if our red blood cell counts fall, then we don’t get enough oxygen, resulting in the following symptoms:
• Chest pain
• Cold hands and feet
• Dizziness
• Fatigue
• Headaches
• Pale skin/yellow skin
• Shortness of breath

Cold Hands

Oncologists diagnose anemia with the blood tests that they perform before chemotherapy. Surgeons order complete blood counts before discharging patients from the hospital to ensure that a patient is not severely anemic. Normal hemoglobin counts are 13.5 – 17.5 for men and 12.0 – 15.5 for women. The 5 grades of anemia are:
0. – None – Normal counts
1. – Mild – 10.0 to normal
2. – Moderate – 8.0 – 10.0
3. – Severe – 6.5 – 7.9
4. – Life-threatening – Below 6.5

What causes cancer patients to become anemic?

There are several reasons that cancer patients are prone to anemia. Our medical team has to know why we are anemic to fix the problem. Let’s look at the reasons.

Blood loss. Excessive blood loss that might occur after surgery may cause anemia. Some cancerous solid tumors bleed causing anemia.
Cancer type. Cancers like leukemia, lymphoma, MDS and multiple myeloma often damage the bone marrow resulting in chronic anemia or recurrent episodes of anemia.

Cancer that metastasizes to the bone. When cancer spreads to the bone, it may invade the bone marrow and suppress production of red blood cells.

Chemotherapy. Chemotherapy is designed to work on fast-growing cells like cancer cells. Unfortunately, chemo also works on other fast-growing cells include your bone marrow that produces red blood cells – resulting in anemia.

Nausea and vomiting. Nausea sometimes causes loss of appetite, and we don’t get the nutrients we need. Uncontrolled vomiting also causes a loss of nutrients. If we lose too much folic acid, iron or vitamin B-12, we will become anemic.

Radiation. Radiation therapy may damage our bone marrow. When large bones are radiated, anemia may develop. If we receive radiation over a large part of our body or to our large bones like the thigh bone or pelvic or chest, we are at risk for anemia.

How do we treat anemia?

The more serious the grade of anemia, the more aggressive your medical team will treat your anemia. Grade 5 anemia is life-threatening because you’re not receiving enough oxygen for your body to function normally … permanent damage to your organs is possible.


Blood transfusions. Serious anemia may require a blood transfusion. Patients with blood cancers such as leukemia, lymphoma, MDS and multiple myeloma may require regular transfusions.

Prescription medications. Your doctor may prescribe erythropoiesis-stimulating agents. We might not be able to pronounce this, but they work by stimulating the bone marrow to make more red blood cells. The name brands of these medications are Aranesp, Epogen, Eprex and Procrit. These medicines are expensive. Your insurance might them deny them, but ask your oncology team to help you get them approved. By staying on schedule with your chemotherapy, you are more likely to achieve treatment success.

Vitamin/Mineral Supplements. Folic acid, vitamin B-12 or iron help mild anemia from developing into more severe anemia. Patients can be proactive and eat a diet rich in iron and B12. These foods include:
• Red meat (beef, pork, lamb and bison)
• Legumes
• Enriched bread and cereal
• Broccoli
• Leafy greens
• Cashew nuts and pumpkin seeds
• Liver
• Quinoa
• Dark meat turkey
• Tofu
• Dark chocolate

The Bottom Line …
Studies show that anemia is common among cancer patients. Even mild anemia causes fatigue, shortness of breath, and cold hands and feet. Added to the fatigue or cold sensitively that chemotherapy causes and many patients feel ready to “throw in the towel.”
Most medical teams usually treat moderate to severe anemia so that we can receive our chemotherapy on schedule and without interruption.
But we as patients should think about being proactive for ourselves – we need to eat healthy for a number of reasons – one of those reasons is to help prevent anemia. We’ll surely feel better if we can avoid it.

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