Anemia

Anemia is a condition that develops when you do not have healthy red blood cells (RBCs). This means the hemoglobin (Hgb) levels in your blood are lower than normal. Hemoglobin is the part of the red blood cell that carries oxygen throughout the body. Without enough oxygen, your body cannot work as it should. 

If your body is not making enough RBCs or is destroying them, you can develop anemia. You may also develop anemia if you lose too much blood from your bloodstream.

Anemia is a common side effect in patients with cancer. Cancer treatments, such as chemotherapy and radiation therapy, as well as cancers that affect the bone marrow, can cause anemia. 

Signs and Symptoms of Anemia

A common sign and symptom of anemia is fatigue, which can best be described as extreme tiredness that cannot be relieved by sleep and rest. This is not the only symptom. Other signs of anemia may include:

• Pale skin, nail beds, mouth, and gums 
• Trouble staying warm. This is due to oxygen not being carried throughout your body effectively. Your body will push more blood to your core where it needs to be to keep your body temperature stable.
• Trouble concentrating, usually from lack of oxygen in your brain. 
• Feeling lightheaded, dizzy, or faint
• Shortness of breath
• Fast breathing 
• Headaches
• Rapid or irregular heartbeat
• Swelling in the hands and/or feet
• Chest pain
• Insomnia

Talk with your doctor if you are experiencing one or more of these symptoms for more than a few days. They can easily run a blood test to see if anemia is likely the cause. 

Diagnosis and Types of Anemia

There are a couple of blood tests used to check for anemia. The primary blood test used to diagnose anemia is called a complete blood count (CBC). The test results include your number of red blood cells.

There are several ways to measure red blood cells. Two of the most common are:

• Hematocrit (Hct), the percentage of your blood that is made up of red blood cells
• Hemoglobin (Hgb), the amount of protein in red blood cells that carries oxygen

Based on the blood count test results, you may need a few other tests to determine the cause of anemia. 

Common Types of Anemia 

• Iron-deficiency anemia – If your iron levels are low, anemia may be improved with increased iron intake. It is usually a good idea to take it with Vitamin C for better absorption into the body. Iron helps your body make more red blood cells.
• Vitamin-deficiency anemia – Other than iron, your body needs a few other vitamins to make healthy red blood cells, including vitamin B12 and folate. There are tests available to check for the amount of these vitamins in your system. You can use supplements to help boost your levels and hopefully start to feel better as your red blood cells increase.
• Anemia caused by other health conditions – Anemia can be caused by conditions that cause chronic inflammation in the body, such as kidney disease, Crohn’s disease, and cancer. These conditions and their treatments can interfere with red blood cell production. 

Less Common Types of Anemia 

There are several other rare types of anemia that are treated by a blood specialist called a hematologist, such as:

• Aplastic anemia – The body does not produce enough red blood cells. Causes of aplastic anemia include infections, certain medicines, autoimmune diseases, and exposure to toxic chemicals.
• Bone marrow disease-related anemia – If there is a disease or other condition in the bone marrow, it can affect red blood cell production, resulting in anemia. Treating the condition should help improve the bone marrow’s ability to produce healthy cells.
• Hemolytic anemias – This group of anemias, which can be inherited, develops when red blood cells are destroyed faster than bone marrow can replace them.
• Sickle cell anemia – This inherited condition is a type of hemolytic anemia caused by a genetic defect in the way hemoglobin is formed in the body. These abnormal red blood cells cannot survive, causing anemia.

Treatment Options for Anemia

Treatments for anemia are based on the type.  

For people with iron-deficient or vitamin-deficient anemia, increasing vitamins and minerals in your diet and through supplements may be enough. You will need to have your blood counts checked regularly to be sure the levels are returning to normal and staying there. 

Eating foods rich in iron or folic acid may also be recommended. The MOH staff can provide you with nutrition counseling that includes personalized nutrition solutions and menu options to help manage anemia.

For other types of anemia, a hematologist will help you identify the best treatment options. A hematologist is a cancer doctor who specializes in diseases of the blood. If the anemia is caused by cancer or a bone marrow condition, they can discuss a treatment plan that is best for your specific type of anemia. 

In some cases, there is no way to fix the cause of the anemia, but medical treatments can help patients feel better. There are two primary treatments for anemia: 

• Medication. Your hematologist may prescribe medications called erythropoiesis-stimulating agents (ESAs). ESAs are forms of erythropoietin made in the laboratory. These substances stimulate the bone marrow to make more red blood cells. Since the goal is to raise your hemoglobin level just enough for you to avoid a blood transfusion, ESAs should be given at the lowest dose possible. Your doctor may lower the dose when the minimum hemoglobin level is reached. 
• Blood transfusion. Patients experiencing symptoms or problems caused by anemia may need a red blood cell transfusion. During the transfusion, healthy red blood cells from a donor go into your body through a needle into a vein (intravenously). This does not necessarily solve the problem, but patients feel much better for periods of time after a transfusion.

Questions to Ask Your Health Care Team About Anemia

Most hematologists work from a cancer center since they also treat cancer. Please note, if you are referred to a hematologist, this does not mean you have cancer! You may want to ask questions that can help you understand the underlying cause of the condition.

Consider adding these questions to your list:

• What is causing the anemia?
• What problems/symptoms 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?
• Can you give me the name of a registered dietitian who could give me advice?
• Are there lifestyle changes I can make to help improve the anemia?

Anemia Treatment Available in Maryland

If your doctor has noticed your red blood cell count is low and iron or vitamins do not solve the problem, you will need to consult with a hematologist like those at Maryland Oncology Hematology.