What are the signs of anemia in people with cancer?

Deep tiredness, breathlessness, and lightheadedness are the three that bring most people in. Alongside them come dizziness or fainting, headaches, a fast heartbeat, and pale skin.

The National Institutes of Health adds weakness, chills, and sometimes jaundice, a yellowing of the skin and the whites of the eyes. Mild anemia may cause no symptoms at all. Symptoms can arrive quickly or creep up over weeks, depending on what is causing it.

Why these particular symptoms

Anemia means the number of red blood cells is below normal. Red blood cells carry oxygen from your lungs to the rest of your body.

Once there are too few of them, every symptom on the list follows from oxygen shortage. Muscles starved of oxygen feel weak and tired. Your lungs work harder, so you feel short of breath. Your heart beats faster to move the remaining cells around more often, which you feel as a racing pulse. The brain gets less oxygen, which produces headache, dizziness, and fainting. Blood is pulled away from the skin, which is why you look pale.

The tiredness of anemia is not ordinary tiredness. Sleep does not fix it, and it can arrive after climbing one flight of stairs.

Where it comes from in cancer

Three sources account for most of it. Chemotherapy and radiation therapy damage the bone marrow where blood cells are made. Cancers that involve the bone marrow directly, such as leukemia, lymphoma, and multiple myeloma, crowd out normal production. And some cancers cause slow blood loss, particularly in the stomach and bowel.

Poor nutrition during treatment adds to it. So can low iron, low vitamin B12, and low folic acid.

When to call, and when to go now

Go to an emergency room or call 911 for chest pain, shortness of breath while sitting still, fainting, confusion, or a heart that is pounding and will not slow down. Also go for black, tarry stools or vomiting blood, which mean active bleeding.

Call your care team the same day if stairs suddenly leave you gasping, if you feel faint standing up, if you notice new bruising or bleeding gums, or if fatigue has clearly worsened since your last visit. Tell them even if you assume it is just the chemotherapy, because anemia is treatable and they cannot fix what they do not know about.

What gets checked and what helps

Diagnosis comes from blood tests, usually a complete blood count that measures your red cells and hemoglobin, the oxygen-carrying protein inside them. Treatment is chosen from your symptoms and from the underlying cause, so the same hemoglobin number can lead to different plans in different people.

Options include medicines, iron supplements, vitamin B12 or folic acid, and blood transfusions. Ask directly whether any of these would help you, because the answer depends on the cause.

Three things you can do while you wait for the cause to be sorted out.

• Spend your energy deliberately. Choose the few things that matter most each day and let people who offer help drive you to appointments or cook.
• Balance rest against movement. Short naps help, but too much bed rest makes weakness worse. Short walks or light exercise most days usually help more than lying still.
• Eat and drink well. Ask your doctor, nurse, or a registered dietitian what suits you, since you may need more protein or more iron.

Questions worth writing down before your next visit: What is causing my anemia? Which problems should I call you about? Would medicine, iron pills, or a transfusion help me? Can you refer me to a registered dietitian?

Sources

https://www.cancer.gov/about-cancer/treatment/side-effects/anemia

https://www.nhlbi.nih.gov/health/anemia/symptoms

https://www.nhlbi.nih.gov/health/anemia

https://medlineplus.gov/ency/article/000560.htm