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What Should I Know About Anemia During Chemotherapy?


Updated June 09, 2014

Mature woman resting her head on her hand
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Anemia due to chemotherapy isn’t something we hear about as often as, say, hair loss, but it is a very common and undertreated side effect of chemotherapy.

What Is Anemia?

Anemia (also known as "low blood" or "iron poor blood") is defined as a decrease in the number of red blood cells (RBCs) or hemoglobin, resulting 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.

Anemia may contribute to fatigue and cause a number of other symptoms that can affect your quality of life.

What Causes Anemia During Cancer Treatment?

There are several causes of anemia during cancer treatment. Some of these include:
  • Chemotherapy medications
  • – Chemotherapy attacks rapidly dividing cells, including the cells that eventually form red blood cells. Chemotherapy may also cause mouth sores, taste changes, or nausea that can reduce your intake of nutrients needed to make red blood cells.

  • Bleeding – Loss of blood due to surgery or from coughing up blood (hemoptysis) can cause anemia.

  • The cancer itself – Anemia can occur with many chronic illnesses, either due to the disease itself or due to nutritional deficiencies resulting from the disease or treatment.

  • Kidney failure -- This is more common in elderly patients and a possible result of dehydration and the cancer itself.


Your physician will order a complete blood count (CBC) before and after chemotherapy. This is what will help her diagnose anemia, if you have it.


Symptoms you may experience with anemia include:
  • Fatigue
  • Lack of energy
  • Lightheadedness or dizziness, especially when sitting up rapidly, or standing
  • Shortness of breath
  • Headaches
  • A pale appearance
  • Rapid heart rate or palpitations
  • Chest pain


Most of the time, mild anemia can be dealt with by simply altering your lifestyle a bit and waiting for your body to make more red blood cells. Insufficient rest, standing up rapidly, or drinking beverages with caffeine or alcohol can worsen your symptoms. At other times, especially if your red blood cell count is very low, or you are experiencing symptoms, your doctor 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 a fever and chills, and the small risk of having a blood transfusion reaction or contracting an infectious disease such as hepatitis.

  • Iron Supplements -- Oral of IV iron supplements might be recommended. Iron taken orally is 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 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 include Epoetin alfa (Epogen, Procrit) and Darbepoetin alfa (Aranesp).

Coping With Anemia During Chemotherapy

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:
  • Get an adequate amount of sleep and nap when needed
  • Stand up slowly, especially when you have been sitting or lying down for an extended period of time
  • Drink plenty of water
  • Avoid caffeine, tobacco, and alcohol
  • Ask for help

When to Call the Doctor

Let your doctor 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.


American Cancer Society. Anemia in People With Cancer. Updated 08/20/12. http://www.cancer.org/Treatment/TreatmentsandSideEffects/PhysicalSideEffects/Anemia/anemia-in-people-with-cancer.

Auerbach, M. and H. Ballard. Intravenous iron in oncology. Journal of the National Comprehensive Cancer Network. 2008. 6(6):585-92.

Cella D. Quality of life and clinical decisions in chemotherapy-induced anemia. Oncology (Williston Park). 2006. 20(8 Suppl 6):25-8.

Davidson, B. Communicating about chemotherapy-induced anemia. The Journal of Supportive Oncology. 2007. 5(1):36-40.

Glaspy, J. Erythropoietin in Cancer Patients. Annual Review of Medicine. 2008. Nov 3. (Epub ahead of print).

Groopman, J. and L. Itki. Chemotherapy-induced anemia in adults: incidence and treatment. Journal of the National Cancer Institute. 1999. 91(19):1616-34.

Kallich, J. Psychological outcomes associated with anemia-related fatigue in cancer patients. Oncology (Williston Park). 2002. 16(9 Suppl 10):117-24.

U.S. Department of Health and Human Services. National Institute of Health. National Heart Lung and Blood Institute Disease and Conditions Index. Anemia. Updated 05/18/12. http://www.nhlbi.nih.gov/health/dci/Diseases/anemia/anemia_whatis.html.

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