Low Red Blood Cell Count (Anemia)

Anemia means you have less red blood cells (RBCs) than you usually do. Most cancer treatments kill cells that grow at a fast rate. RBCs grow at a fast rate so are often affected. An important part of RBCs is hemoglobin. Hemoglobin is the protein that carries oxygen throughout your body. When your hemoglobin is low, your oxygen levels go down. Your body has to work harder to make up for the lower oxygen. The end result is that your body gets tired.

Normal hemoglobin levels for women are usually in the range of 12-16 gm/dL; and for men are in the range of 14-18 gm/dL. While getting treatment, your hemoglobin level may drop to lower than normal levels. Your hemoglobin level will be checked during treatment. Any time that your hemoglobin level drops below 10.0 gm/dL, it means you are anemic.

Signs and symptoms of anemia are:

• Weakness or fatigue.
• Dizziness.
• Headache or feeling lightheaded.
• Shortness of breath or difficulty breathing.
• Palpitations (fast, fluttering, or pounding heartbeat).
• Chest Pain.
• Pale skin.
• Feeling cold, particularly in the hands and feet.
• Swelling in the hands or feet.

What can I do?

There is nothing that you can do to prevent anemia. Anemia may make you feel weak and tired. Some ways to help you feel better are:

Saving energy

• Get plenty of sleep.
• Avoid long or very tiring activities.
• Pace yourself; take time to rest when doing activities that make you feel tired. 
• Take short naps when needed.
• Prioritize your activities so you will have enough energy for important activities or the ones that you enjoy most.
• Ask friends and family to help. Ask them to prepare meals or do chores when you're tired.

Try to avoid injury

• Change positions slowly, like when going from lying to standing to prevent dizziness.
• When getting out of bed, sit on the side of the bed for a few minutes before standing.

Eat a well-balanced diet

• Eat foods high in iron (green leafy vegetables, liver, and cooked red meats).
• Drink lots of fluids.
• Do not drink caffeine.
• Do not eat big meals late in the day if you're having trouble sleeping at night.
• Take iron supplements only if you have been told to by your provider.

When should I call my provider?

Call your provider right away if you have any of these symptoms:

• Dizziness.
• Shortness of breath or difficulty breathing.
• Excessive weakness or fatigue.
• Palpitations or chest pain.

How is anemia treated?

There are many ways to treat anemia. Your provider may tell you to take over-the-counter iron pills daily or may order blood transfusions. They may also recommend B12 or folic acid supplements.

Your provider may order injections of a "growth factor", which can be used to stimulate the growth of red blood cells. By increasing how many red blood cells your body is making, this growth factor may lower your risk of becoming anemic, and may also lower the number of blood transfusions you may need.

Growth factors are given by injection. You may get the injections from the oncology nurse, or you and/or a family member may be taught how to give them at home. Once your red blood cell count is back to a normal level, the injections will be stopped.

Your provider may delay treatments until your red blood cell count has gone back to normal levels.