This page was reviewed under our medical and editorial policy by

Maurie Markman, MD, President, Medicine & Science

This page was updated on March 2, 2022.

The red blood cells in your body have an important role. The hemoglobin in red blood cells delivers oxygen and removes carbon dioxide. If you don’t have enough red blood cells, your body may not get enough oxygen, which may cause different symptoms and health problems.

Anemia is the name for a low level of red blood cells, and it’s a common side effect of cancer and cancer treatments.

There are several reasons why anemia is more common when you have cancer:

  • You’re undergoing chemotherapy or radiation treatment, which may damage bone marrow (where red blood cells are made).
  • You’re receiving a platinum-based chemotherapy drug, such as cisplatin and carboplatin, which may hurt the kidneys. Kidney damage may cause your body to make fewer red blood cells or cause the red blood cells to live in the body for a shorter amount of time.
  • You have chronic kidney disease.
  • You’re losing blood.
  • You had a low level of hemoglobin before you had cancer.
  • The cancer itself may cause anemia. Leukemia, lymphoma, multiple myeloma and cancer that goes to the bone or bone marrow may damage bone marrow or block healthy red blood cells.
  • You aren’t getting enough of certain vitamins or minerals. Iron, folic acid and vitamin B12 are involved with making red blood cells. Or, you may lose these nutrients through decreased appetite, nausea and vomiting.
  • Your body destroys red blood cells before they get replaced.
  • You have an inherited disorder of red blood cells, such as sickle cell disease.

Symptoms of anemia

Symptoms associated with anemia include:

  • Faster than normal or irregular heartbeat
  • Faster breathing
  • Chest pain
  • Dizziness or fainting
  • Fatigue
  • Lighter than normal color of skin, gums, lips, nail beds or tongue
  • Trouble concentrating
  • Headaches
  • Insomnia

If you have these symptoms, it doesn’t always mean that you have anemia. These symptoms are associated with other health problems as well. However, you should inform your cancer care team if you have:

  • Blood in your stool
  • Chest pains
  • Dark brown or bright red vomit
  • Shortness of breath when resting
  • Dizziness or faintness
  • Confusion
  • Tiredness that keeps you in bed for more than 24 hours

If you experience these symptoms but can’t reach your care team, go to an emergency room. Anemia may be mild or it may be life-threatening. Make sure to monitor for these symptoms during cancer treatment.

Diagnosing anemia

Doctors use a variety of tests to screen for anemia. These tests include:

  • Complete blood count, which measures hemoglobin and other characteristics of red blood cells
  • Blood test to detect folate, iron and vitamin B12
  • Blood chemistry tests that check your organ function and levels of vitamins and minerals
  • Bone marrow exam
  • Reticulocyte count (blood test that measures new red blood cell activity)
  • Stool test

For certain types of cancer or cancer treatments, you may have regular complete blood count tests to check your hemoglobin and look for other blood-related problems.

Treatment for anemia from cancer treatment

Since anemia has different causes, it’s usually treated according to what caused it, which may mean a delay in cancer treatment.

Treatments used most frequently for cancer-related anemia include:

  • Blood transfusion
  • Iron therapy, with iron pills or iron delivered via an infusion
  • Erythropoiesis-stimulating agents are drugs that direct the body to make more red blood cells. These drugs may have serious side effects such as blood clots, but they also may lead to fewer blood transfusions and a gradual improvement of your anemia. You receive erythropoiesis-stimulating agents as shots under the skin.
  • Vitamin B12 or folic acid supplementation

8 tips to manage anemia from cancer and cancer treatments

Managing anemia while undergoing cancer treatments may be tough, but there are some things you can do to try and lessen the effects.

1. Learn more about your anemia. Some questions to ask your cancer care team include:

  • What is causing my anemia?
  • When should I call you about anemia-related symptoms?
  • What can I do to feel better?
  • Would iron pills, medicine or a blood transfusion help me?

2. Lean on loved ones. This can go a long way toward conserving your energy for tasks you think are the most important. Allow others to help you with tasks such as prepping meals or driving to appointments.

3. Make a daily plan for rest and activity. For example, short naps may help you make it through the day. Make sure to intersperse naps with short walks or bursts of exercise, so you don’t become too weak from bed rest.

4. Connect with a registered dietitian for guidance on what to eat. He or she may advise on the foods best tailored for your needs.

5. Add more foods rich in iron and folic acid to your diet. Follow any guidance provided by your care team or a registered dietitian. Some foods high in iron are:

  • Almonds
  • Beans
  • Broccoli
  • Enriched breads and cereals
  • Red meat

Some foods high in folic acid are:

  • Asparagus
  • Broccoli
  • Enriched breads and cereals
  • Spinach

6. Keep a diary of symptoms. This is helpful information for when you sit down with your care team. Write down (on paper or electronically) the time of day that your anemia symptoms happen and what makes them better or worse.

7. Plan activities for the times of day when you have the most energy.

8. Stay hydrated. Unless your care team says otherwise, drink eight to 10 glasses of water daily (8 ounces each). Liquids other than water are fine except for alcoholic drinks, which dehydrate you.

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