Low Red Blood Cell Count

Anemia is a decrease in the number of red blood cells (RBCs). Since chemotherapy destroys cells that grow at a fast rate, red blood cells are often affected. Patients receiving a combination of radiation therapy and chemotherapy are at greater risk for anemia. An important part of the RBC is hemoglobin, the part that carries oxygen throughout your body. Therefore, when your hemoglobin is low, oxygen levels are decreased and your body has to work harder in order to compensate. The end result is that your body will show signs of being very tired.

Normal hemoglobin levels for women are usually in the range of 11.8 to 15.5 gm/dL; for men, the normal level is from 13.5 to 17.5 gm/dL. While receiving chemotherapy/radiation therapy, your hemoglobin level may drop to lower than these normal levels, so your hemoglobin level will be checked periodically throughout the course of treatments. Any time that your hemoglobin level drops below 12.0 gm/dL, you are considered to be anemic.

The signs and symptoms of anemia include:

• weakness or fatigue
• dizziness
• headache
• shortness of breath or difficulty breathing
• chest pain or palpitations
• irritability
• a heavy feeling in your upper legs
• ringing in the ears
• feeling chilled

What Can I Do to Prevent Anemia?

Since red blood cells are destroyed as a side effect of chemotherapy/radiation therapy, there is nothing specifically that you can do to prevent anemia from occurring. Anemia usually causes you to feel weak and tired; therefore, it is very important that when you are anemic you try to prevent your body from becoming extremely tired. Failure to do so may result in your becoming ill. Specific actions to take include:

Rest as much as you can to save your energy.

• Get plenty of sleep.
• Avoid prolonged or strenuous activity.
• Pace yourself. Take rest periods during activities that make you feel tired. If necessary, take short naps throughout the day.
• Prioritize your activities so you will have enough energy for important activities or the activities that you enjoy the most.
• Ask friends and family to help you prepare meals or do chores when you are tired.

Be careful to avoid injury if you are experiencing dizziness.

• Change positions slowly especially when going from lying to standing.
• When getting out of bed, sit on the side of the bed for a few minutes before standing.

Eat a well-balanced diet.

• Eat foods high in iron, including green leafy vegetables, liver and cooked red meats.
• Drink plenty of fluids.
• Avoid caffeine and big meals late in the day if you're having trouble sleeping at night.
• Take iron supplements only if your oncologist or nurse practitioner/physician assistant has told you to do so.

When Should I Call My Doctor?

Call your doctor immediately if you have any one or more of the following:

• dizziness
• shortness of breath or difficulty breathing
• excessive weakness or fatigue
• palpitations or chest pain

How is Anemia Treated?

Depending on the cause and severity of the anemia, there are several ways that anemia can be treated. Your doctor may instruct you to take over-the-counter iron pills on a daily basis or may order blood transfusions.

Your doctor may also choose to order injections of a "growth factor" (Aranesp or Procrit). These substances work by stimulating the body's production of erythropoietin. An important growth factor used with cancer patients stimulates the growth of red blood cells. By increasing your body's production of red blood cells, this growth factor may decrease your risk of becoming anemic, and may also decrease the number of blood transfusions that may be required during your treatment.