Living with cancer


Anaemia occurs when your red blood count is lower than normal. Haemoglobin is an important part of your red blood cells. At normal levels haemoglobin supplies your body with the oxygen it needs to work properly. When haemoglobin is too low, less oxygen is delivered to your body’s cells and tissues, and you may feel weak or tired.

Anaemia can occur in people receiving cancer treatment for a number of reasons including chemotherapy, blood loss, and iron deficiency. Cancer treatments like chemotherapy and radiotherapy are designed to destroy cancer cells but can also damage healthy cells, including red blood cells that carry oxygen throughout the body. Chemotherapy, in particular, can also suppress the production of red blood cells in the bone marrow and affect kidney function which is involved in red blood cell production.

Anaemia related fatigue is very common amongst people receiving cancer treatment and many people report that it affects their daily lives more than any other side effect of treatment. If left untreated anaemia can strain the heart and cardiovascular system and result in the need for blood transfusions. Cancer treatment may have to be delayed until the anaemia has resolved.

Haemoglobin in the blood is measured as part of a full blood count (FBC) test. Haemoglobin is measured in grams per 100 millilitres which is abbreviated to g/dl.

The normal range for a man is 13.5 to 17.5 g/dl and for a woman 11.5 to 15.5 (your healthcare team may abbreviate this to just the numbers) anything less than these numbers is called anaemia. Checking for anaemia is one of the reasons blood tests are taken so frequently throughout cancer treatment.

What are the symptoms of anaemia?

Anaemia can be difficult to identify because early symptoms may be mild. Fatigue is one of the main symptoms although fatigue can occur for other reasons. Sometimes people receiving cancer treatment are hesitant to tell their healthcare team how tired they are because they want the healthcare team to see them doing well. Other times people simply associate fatigue with being unwell, assume it is a normal part of cancer treatment or worry that the cancer is getting worse.

Besides fatigue and weakness other symptoms of anaemia include:

  • shortness of breath
  • confusion or difficulty concentrating
  • dizziness or fainting
  • pale skin, including decreased pinkness fo the lips, gums lining of the eyelids, nail beds and palms
  • rapid heartbeat
  • feeling cold
  • sadness or depression.

How is anaemia treated?

Treatment of anaemia varies depending upon the cause and extent of the condition. If your cancer treatment is especially likely to cause anaemia your healthcare team may suggest treatment with red blood cell growth factors. These are a particular type of biotherapy that stimulate bone marrow cells to divide and to develop into white blood cells, red blood cells and platelets. They are usually given as injections. Blood cell growth factors are not routinely used for all people receiving cancer treatment as they are also associated with side effects including bone pain, fatigue, fever and appetite loss.

Severe anaemia is usually treated using blood transfusions.

You can be an active partner by letting your healthcare team know if you are experiencing fatigue and help them to understand how it is affecting your daily activities. If your fatigue is related to anaemia this can be treated to improve your quality of life and keep your treatment on track wherever possible.

Things to do

  • Tell your healthcare team if you have symptoms of shortness of breath, dizziness or rapid heartbeat.
  • Let your healthcare team know if you are struggling with fatigue.
  • Eat a well balanced diet.
  • Conserve energy by organising daily activities or delegating tasks to family members and friends.
  • Observe for signs of bleeding or blood loss such as from haemorrhoids or diarrhoea. Notify your healthcare team if you have any signs of blood loss.

Things to avoid

  • Over-exertion and over-committing yourself to activities that may not be possible to complete.
  • Dehydration, try to drink 6-8 glasses of water a day.
  • Sleeping too much during the day. Use your bed and bedroom for the majority of your sleep time. Take naps in a chair or on your couch.