Anemia: What to Do When You Have It

Anemia means that the number or quality of the red blood cells is lower than normal. It can be caused by lots of things that prevent the body from being able to make enough red blood cells, such as

• anti-cancer treatment (chemotherapy and radiation therapy),

• not having enough of your body's building blocks (such as iron, vitamin B12, or folate), or

• the cancer itself (anemia of chronic disease).

It can also be caused by blood loss (like during surgery) or if the body breaks down too many red blood cells (called hemolysis). Whatever the cause, your body needs red blood cells, because they carry oxygen throughout your body with iron proteins, (called hemoglobin). Red blood cells also take away the waste product carbon dioxide from your body's cells. If you do not have enough red blood cells, or they don't work just right, you will have symptoms of too little oxygen in your body. Frequent blood tests will be done to measure your hemoglobin and hematocrit during your treatment. The symptoms get worse as the hemoglobin level in the blood gets lower. Symptoms may include:

• Increased heart beat (called tachycardia)

• Irregular heart beat

• Feeling tired a lot (called fatigue)

• Headache

• Having trouble sleeping

• Dizziness or fainting

• Bleeding or oozing

• Blood in urine or stool

• Shortness of breath

• Increased breathing rate

• Weakness

• Pale skin and lips (called pallor)

• Hearing your heartbeat

Learning Needs

It's very important for you to know the cause of anemia, signs and symptoms to watch for, possible treatment options, and how to take care of yourself if you are anemic. Also, it is important for you to know who and when to call if you have questions or problems. Some people may want to know what their hemoglobin level is, and to follow the hemoglobin levels during treatment.

Prevention

Depending upon its cause, sometimes anemia can be stopped before it starts.

• Sometimes anemia is expected, such as with certain chemotherapy or radiotherapy treatments. In this case, your doctor may decide to give you the medicine erythropoietin to help your body make more red blood cells. This may lower the chance that you will become anemic or need to get blood transfusions. The shots do not work for everyone.

• It is important to have enough iron in your body to make red blood cells. So make sure that you eat enough foods containing iron, such as green leafy vegetables, liver, nuts, egg yolks, whole grain cereals, shellfish, apricots, peaches, and molasses.

• Anemia that is related to not having enough folic acid in your blood can be fixed by taking folic acid pills and eating foods high in folic acid, like green leafy vegetables, fish, oatmeal, beef liver, wheat bran, peanut butter, and bananas.

• Sometimes surgery to the stomach (like total gastrectomy) or poor eating habits can make your vitamin B12 level low, and this causes anemia. This can be corrected and then prevented by taking vitamin B12 shots.

Management

Anemia can be treated in a lot of ways. Also, there are things you can do to make the problems of anemia less so that you feel better. Your nurse or doctor will tell you which treatments are right for you.

Treatment of Anemia (depending upon cause):

• Red blood cell transfusion

• Erythropoietin shots

• Iron pills

• Vitamin B12 shots

• Folate pills

Things you can do:

• Pace your activities so that you alternate rest and activity periods.

• Limit your activities to those that are most important to you.

• Try easier or shorter versions of the activities you usually enjoy.

• Ask for help from family or friends to do big tasks like food shopping, cooking, or housework.

• Eat well. Making sure that you have small, frequent meals of foods with calories to give you energy during the day , and protein to make new red blood cells.

• Eat foods high in iron and folic acid to correct low blood levels.

• Limit caffeine and alcohol.

• Take short walks or do light exercise, if possible.

• Consider activities such as meditation, prayer, yoga, guided imagery, or visualization.

• Try to get enough sleep at night, and take naps during the day to manage tiredness.

• Join a support group. Your doctor or nurse may be able to help you find one in your area.

• Talk to your doctor or nurse about ways to conserve energy and reduce fatigue.

• Report any changes in your energy level to your doctor.

• If your doctor gives you erythropoietin or vitamin B12, learn to give yourself the injections.

• If your doctor gives you iron pills, take them between meals and with a juice containing vitamin C.

Follow-up

It is very important that you understand about anemia, and how to take care of yourself. If you don't understand any part of this handout, make sure you ask your doctor or nurse. Know how to call your doctor or nurse if you have a problem or questions. Know when your next appointment is, and always go to your appointments.