Coping With Anemia During Chemotherapy

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Anemia due to chemotherapy isn’t something we hear about as often as, say, hair loss, but it is a very common and undertreated side effect of chemotherapy. Anemia can result in fatigue and lightheadedness as well as other symptoms, but fortunately, it is relatively easy to diagnose with a complete blood count. When severe, treatment options can include blood transfusions, iron supplements, or medications to stimulate blood cell production. That said, anemia related to chemotherapy can often be managed with conservative measures to cope with the symptoms. Learn about anemia during chemotherapy and what you can do to lessen its impact on your life.

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Also known as "low blood" or "iron poor blood," anemia is defined as a decrease in the number of red blood cells (RBC) or hemoglobin. This results in a diminished ability of the blood to carry oxygen to body tissues.

Anemia is usually defined as a hemoglobin less than 13.5 grams/100 ml in men and less than 12 grams/100 ml in women.


Anemia during chemotherapy is extremely common, with one study finding that 89.5% of people with solid tumors receiving chemotherapy experienced some degree of anemia. Thankfully, the vast majority of these people suffered only mild to moderate anemia.


In addition to the obvious fact that anemia can worsen the fatigue that is already common with cancer, anemia can negatively impact cancer treatment in other ways. It's been found that moderate or severe anemia due to chemotherapy can result in delay of subsequent chemotherapy sessions or the need to reduce the dose (which may, in turn, result in lower effectiveness).


Symptoms you may experience with anemia include:

It can contribute to fatigue and cause a number of other symptoms that can affect your quality of life.

  • Fatigue
  • Lack of energy
  • Lightheadedness or dizziness, especially when sitting up rapidly or standing
  • Shortness of breath
  • Headaches
  • Pale appearance
  • Rapid heart rate or palpitations
  • Chest pain


There are several causes of anemia during cancer treatment, including:

  • Chemotherapy medications—Chemotherapy attacks rapidly dividing cells, including the cells that eventually form red blood cells. It may also cause mouth sores, taste changes, or nausea that can reduce your intake of nutrients needed to make red blood cells.
  • Bleeding—Loss of blood due to surgery or from coughing up blood (hemoptysis) can cause anemia.
  • The cancer itself—Anemia can occur with many chronic illnesses, either due to the disease itself or due to nutritional deficiencies resulting from the disease or treatment.
  • Kidney failure—This is more common in elderly patients and a possible result of dehydration and the cancer itself.


Your healthcare provider will order a complete blood count (CBC) before and after chemotherapy to assess your red blood cell count as well as hemoglobin. A CBC also includes information (called red blood cell indices) about the red blood cells in your blood, such as the size (MCV), amount of hemoglobin (MCHC) and variety of sizes (RDW). These tests can help further define your anemia.

It's important to note that there are many types of anemia and many causes in addition to chemotherapy. Sometimes further testing is needed to evaluate that precise causes. For example, a combined anemia (such as the combination of chemotherapy related bone marrow suppression plus vitamin B12 deficiency) may not be obvious from a complete blood count alone. Further testing may include:

  • Peripheral smear for morphology: With a blood smear, the blood cells are looked at under the microscope rather than in an automated machine alone, and changes such as fragmentation of red blood cells etc. may be seen.
  • Reticulocyte count: This test looks at the maturity of your red blood cells and can help answer the question about whether your anemia is due to lack of production of red blood cells or something else (such as bleeding or breakdown in the circulation).


Most of the time, mild anemia can be dealt with by simply altering your lifestyle a bit and waiting for your body to make more red blood cells. Insufficient rest, standing up rapidly, or drinking beverages with caffeine or alcohol can worsen your symptoms.

At other times, especially if your red blood cell count is very low or you are experiencing symptoms, your healthcare provider may recommend treatment. Options for treatment include:


The fastest way to increase red blood cells is with a blood transfusion. Side effects can include fever, chills, and the small risk of having a blood transfusion reaction or contracting an infectious disease, such as hepatitis.

Iron Supplements

Oral or IV iron supplements might be recommended. Iron taken orally is easiest but can cause stomach discomfort. Common side effects of intravenous iron are a transient feeling of flushing, a metallic taste, headaches, and joint or muscle aches a few days after treatment. Occasionally, iron injections can cause allergic reactions that can be serious.

Medications to Stimulate Formation of Red Blood Cells

Medications are sometimes used (often along with intravenous iron) to stimulate the production of red blood cells in your body. There is currently a lot of controversy about this treatment and your oncologist will discuss the benefits and possible risks if this is recommended. These medications include Procrit or Epogen (epoetin alfa) and Aranesp (Darbepoetin alfa).


The best way to cope with anemia is to allow yourself to take it easier than usual until your body is able to catch up and make more red blood cells. The good news is that anemia is one cause of fatigue that is very treatable and it will usually begin to improve a few weeks after completing chemotherapy.

While you are anemic, try to:

  • Get an adequate amount of sleep and nap when needed.
  • Stand up slowly, especially when you have been sitting or lying down for an extended period of time.
  • Drink plenty of water.
  • Avoid caffeine, tobacco, and alcohol.
  • Ask for help.

When to Call the Healthcare Provider

Let your healthcare provider know if you are experiencing any symptoms that may be due to anemia. Between visits, call if you notice any of these symptoms worsening, especially if you become more short of breath, your heart rate is more rapid than usual, you feel fatigued despite rest, or if you feel lightheaded or disoriented.

For Loved Ones

As noted above, one of the best ways in which people can cope with anemia during chemotherapy is by asking for help. That said, many people living with cancer hesitate to ask for help. They fear being a burden or losing their sense of independence. As a friend or family member you can help by being aware of these, and being ready to step in even when your loved one fails to ask.

11 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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Additional Reading

By Lynne Eldridge, MD
 Lynne Eldrige, MD, is a lung cancer physician, patient advocate, and award-winning author of "Avoiding Cancer One Day at a Time."