Anemia, Transfusions, and Cancer Fatigue

If treatment has left you exhausted in a way sleep does not fix, anemia is worth checking. It is measurable with a blood test, and there are things your team can do about it.

Anemia is a condition in which the number of red blood cells is below normal. Red blood cells are the cells that carry oxygen from the lungs throughout your body to help it work properly. When you are anemic, your body does not have enough red blood cells, so less oxygen reaches the places that need it.

Cancer treatments, such as chemotherapy and radiation therapy, as well as cancers that affect the bone marrow, can cause anemia.

Anemia also feeds into the larger problem of cancer-related fatigue. NCI lists anemia among the treatment side effects that can cause or worsen fatigue, along with appetite loss, diarrhea, hot flashes, infection, pain, sleep problems, and vomiting. Chemotherapy destroys healthy cells while treating cancer cells, which on its own can leave you feeling fatigued.

Anemia can make you feel very tired, short of breath, and lightheaded. Signs of anemia may also include feeling dizzy or faint, headaches, a fast heartbeat, and pale skin. Weakness and unusually pale skin are also described as symptoms of anemia.

You will have blood tests to check for anemia. Treatment for anemia is also based on your symptoms and on what is causing the anemia.

So two things drive the plan: the number on your blood count, and how you feel and function day to day. Both belong in the conversation.

A red blood cell transfusion is given when the red blood cell count is low and signs or symptoms of anemia, such as shortness of breath or feeling very tired, occur. A transfusion is a way of giving you red blood cells to replace blood cells that have been destroyed by disease or by cancer treatment.

A transfusion is not the only option. It is worth asking your team directly: would medicine, iron pills, a blood transfusion, or other treatments help me? The right answer depends on the cause and on your symptoms.

There is one longer-term consideration if transfusions become routine. Patients who receive many blood cell transfusions may have tissue and organ damage caused by the buildup of extra iron. These patients may be treated with iron chelation therapy to remove the extra iron from the blood. If you are heading toward repeat transfusions, ask how your iron levels will be watched.

These are the steps NCI suggests if you have fatigue caused by anemia.

• Save your energy and ask for help. Choose the most important things to do each day. When people offer to help, let them do so. They can take you to the doctor, make meals, or do other things you are too tired to do.
• Balance rest with activity. Take short naps during the day, but keep in mind that too much bed rest can make you feel weak. You may feel better if you take short walks or exercise a little every day.
• Eat and drink well. Talk with your doctor, nurse, or a registered dietitian to learn what foods and drinks are best for you. You may need to eat foods that are high in protein or iron.

Tell your health care team if you feel very weak and tired, especially if you are not able to do your normal activities or are still very tired even after resting or sleeping.

Also report new or worsening signs of anemia: shortness of breath, feeling lightheaded, dizzy, or faint, headaches, a fast heartbeat, or pale skin.

Because thresholds differ from person to person and treatment to treatment, ask your own team the question NCI recommends asking: what problems should I call you about? Get that answer before you need it, and write down the number you should use.

• What is causing the anemia?
• What problems should I call you about?
• What steps can I take to feel better?
• Would medicine, iron pills, a blood transfusion, or other treatments help me?
• Would you give me the name of a registered dietitian who could also give me advice?

• Call 911 or go to an emergency department if you have chest pain, a heartbeat that races or flutters, or breathlessness that is there even when you are sitting still. New or worsening confusion belongs on this line too. So does a reaction after a transfusion: chills with a fever, back pain, or urine that turns dark or bloody in the hours afterwards. If that starts while the blood is still running, tell the nurse at once so the transfusion can be stopped.
• Call 911 or go to an emergency department if bleeding will not stop despite firm pressure, or if you vomit blood that is bright red or looks like coffee grounds. That is active bleeding, and with a low blood count it can empty you fast.
• Call your care team the same day if you faint, come close to fainting, or have a fall, or if your stools are black or red.
• Call your care team within a day or two if stairs or short walks newly leave you gasping, or if you have not managed to get out of bed for a full day.

These urgency levels follow the American Cancer Society's guidance on anemia in people with cancer.

• American Cancer Society — Anemia in People with Cancer: https://www.cancer.org/cancer/managing-cancer/side-effects/low-blood-counts/anemia.html
• National Cancer Institute — Anemia: Cancer Treatment Side Effect: https://www.cancer.gov/about-cancer/treatment/side-effects/anemia
• MedlinePlus — Hemolytic transfusion reaction: https://medlineplus.gov/ency/article/001303.htm
• National Cancer Institute — Fatigue and Cancer Treatment: https://www.cancer.gov/about-cancer/treatment/side-effects/fatigue
• National Cancer Institute — Myelodysplastic Syndromes Treatment (PDQ), Patient Version: https://www.cancer.gov/types/myeloproliferative/patient/myelodysplastic-treatment-pdq