Anaemia can be due to various causes including blood loss, red blood cell destruction (also referred to as haemolysis) or the body not producing enough red blood cells (e.g. due to a deficiency of nutrients required by the bone marrow).1
Anaemia occurs when you have low levels of red blood cells in your body.
- Iron-deficient anaemia – occurs when there is not enough iron in your body. Iron is vital for the body to produce the protein haemoglobin, which transports oxygen around your body in your red blood cells.2
- Aplastic anaemia – occurs if the bone marrow is significantly underactive. The bone marrow is responsible for making all the blood cells in your body, including red blood cells, white blood cells and platelets.2
- Pernicious anaemia – is a disorder characterised by the body being unable to absorb enough vitamin B12 from your diet to produce red blood cells.2 Both vitamin B12 as well as folate (also a B vitamin) are required for healthy red blood cell formation.2
- Hemolytic anaemia – occurs when red blood cells are destroyed faster than they can be made.2 Typically red blood cells have a lifespan of three months, however in some inherited conditions (such as sickle cell disease and thalassemia) the body destroys red blood cells before the end of their lifespan.3
Anaemia is relatively common in people with cancer, being seen in 40-50% in people with cancer.4,5
Anaemia in patients with cancer can be due to many different factors including:
- Certain cancer treatments such as radiation therapy, as well as chemotherapy drugs – these can damage bone marrow tissue where blood cells are made. Certain drugs can also damage the kidneys, where a hormone (erythropoietin) is made, which helps make the red blood cells in the bone marrow.1
- Certain types of cancers – such as blood cancers and cancers that spread to the bone marrow eg. ovarian and lung tumours.1, 3
- Side effects of cancer and cancer treatments – these can often cause vomiting and nausea and poor appetite, which can result in low levels of iron, folate and B12.1
- Blood loss – this can be as a result of surgery or internal bleeding arising from the cancer itself.1
Typical symptoms of anaemia include: 1
- Fatigue and tiredness
- Irregular or rapid heart rate
- Pains in your chest
- Cold hands or feet
- Difficulty catching your breath
If you experience any of these symptoms, it is important you see your doctor straight away.
The treatment of anaemia will be dependent on your symptoms as well as the cause of your anaemia. Treatment options can include:
- Supplementation – iron, B12 or folate (folic acid) can be prescribed, usually as tablets, although iron can be given as an infusion and vitamin B12 given as an injection.1
- Increasing your intake of iron-rich foods
- Blood transfusion – if your haemoglobin is very low, or if your levels need to be increased quickly.3
- Medication – if your anaemia is a result of chemotherapy, you may be prescribed medication that increases the production of erythropoietin, known as erythropoietin stimulating agents (ESAs), which help your bone marrow make more red blood cells.1
Anaemia is diagnosed through a blood test (called a Complete Blood Count (CBC) or Full Blood Count (FBC)) which can be ordered by your doctor. In Australia, haemoglobin levels range between approximately 120g/L – 160g/L for women, and 130g/L – 180g/L for men.6 Anaemia is diagnosed when haemoglobin levels is below these ranges.
There are many things you can do to help manage your symptoms of anaemia including:
- Take short naps and rest where you can
- Ask for help and accept offers of help when given
- Keep up your fluid intake or speak to a registered dietitian for advice on dietary changes you could make.
In the diet there are two main sources of iron, known as heme-iron (these are animal-based foods) and non-heme iron (these are plant-based foods). Animal-based sources of iron are more easily absorbed by your body, compared with plant-based sources.
Animal-based sources of iron in the diet include: Red meat such as lean beef and lamb, chicken and fish as well as eggs.8
Plant-based sources of iron in the diet include: green leafy vegetables, dried lentils, nuts and seeds as well as foods that have been iron-fortified (had iron added to them) such as cereals and spreads.8
- American Society for Clinical Oncology (ASCO).(2019). Anaemia. Retrieved on 12th June 2019 from https://www.cancer.net/coping-with-cancer/physical-emotional-and-social-effects-cancer/managing-physical-side-effects/anemia
- NIH: National Heart, Lung and Blood Institute. (2011). In brief: your guide to anaemia. Retrieved on 12th June 2019 from https://www.nhlbi.nih.gov/files/docs/public/blood/anemia-inbrief_yg.pdf
- American Cancer Society. (2017). Anaemia in people with cancer. Retrieved on 12th June 2019 from https://www.cancer.org/treatment/treatments-and-side-effects/physical-side-effects/low-blood-counts/anemia.html
- Ludwig, H., Van Bell, S., Barrett-Lee, P, et al. (2004). The European Cancer Anaemia Survey (ECAS): A large, multinational, prospective survey defining the prevalence, incidence, and treatment of anaemia in cancer patients. European Journal of Cancer. 40 (15). Retrieved on 12th June 2019 from https://www.sciencedirect.com/science/article/pii/S0959804904005118
- Seshadri, T., et al. (2005). The Australian Cancer Anaemia Survey: a snapshot of anaemia in adult patients with cancer. The Medical Journal of Australia. 182 (9). Retrieved on 12th June 2019 from https://www.mja.com.au/journal/2005/182/9/australian-cancer-anaemia-survey-snapshot-anaemia-adult-patients-cancer
- Australian Red Cross Blood Service. (n.d). Retrieved on 12th June 2019 from https://mytransfusion.com.au/reasons-transfusion/anaemia
- National Cancer Institute. (n.d). Anaemia and Cancer Treatment. Retrieved on 12th June 2019 from https://www.cancer.gov/about-cancer/treatment/side-effects/anemia?redirect=true
- Dietitians Association of Australia. (n.d). Anaemia: my doctor says I need more iron. Retrieved on 12th June 2019 from https://daa.asn.au/smart-eating-for-you/smart-eating-fast-facts/nourishing-nutrients/anaemia-my-doctor-says-i-need-more-iron/
- American Society of Haematology. (n.d). Anaemia. Retrieved on 12th June 2019 from https://www.hematology.org/Patients/Anemia/