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Anemia and Leukemia: How It Can Worsen Fatigue

Posted on January 27, 2022
Medically reviewed by
Todd Gersten, M.D.
Article written by
Julie Scott, ANP-BC, AOCNP

Anemia occurs when the number of red blood cells is lower than normal. Anemia can be a problem for people living with leukemia, and it can have a significant impact on someone’s quality of life. There are many potential causes for anemia, and people living with leukemia may have more than one risk factor for developing anemia. Diagnosing anemia and treating it is an important step to feeling your best when living with leukemia.

Red blood cells carry a protein called hemoglobin that is responsible for transporting oxygen throughout the body. In anemia, hemoglobin levels are lower than normal, and the ability to take oxygen where it’s needed is decreased. This can lead to the development of various symptoms, as the heart, lungs, and other body systems need to work harder to compensate for the decreased hemoglobin.

Symptoms of Anemia

There are many symptoms associated with anemia, and many of them are also common symptoms of leukemia or side effects from cancer treatments.

Fatigue

Fatigue is a common symptom of anemia. Because people with leukemia often experience fatigue, anemia can worsen these feelings of being tired, feeling weak, and sometimes feeling unmotivated to engage in activity.

Anemia causes or worsens fatigue because the organs and tissues of the body are not receiving enough oxygen to perform their normal functions.

Other Symptoms of Anemia

Anemia can also cause heart or lung symptoms such as:

  • Chest pain
  • Elevated heart rate
  • Shortness of breath

Other symptoms of anemia can include:

  • Feeling cold often
  • Pale skin
  • Brittle nails

Some of these side effects can be the same as symptoms experienced with leukemia or side effects from leukemia treatments.

How Does Anemia Affect People Living With Leukemia?

MyLeukemiaTeam members often discuss how anemia affects them.

“The fatigue is annoying,” wrote one member diagnosed with anemia. “Sometimes, you want to do more and the body says ‘not now.’” Another member with a low red blood cell count shared, “It’s frustrating not being able to do anything but eat and putter around. No energy. The only time I’m comfortable is lying down.” Another MyLeukemiaTeam member posted, “This disease has robbed me of my energy level due to being anemic.”

Other members described the effects of anemia:

  • “Tiredness beyond belief.”
  • “I feel weak and tired and can barely walk.”
  • “I freeze all of the time.”
  • “I’m so pale I look like Casper the Friendly Ghost.”
  • “Weak and short of breath due to the anemia.”

Diagnosing Anemia

A simple blood test is needed to check hemoglobin levels. Anemia is diagnosed when the hemoglobin level in the blood is lower than normal. Hemoglobin is measured in grams per deciliter, or g/dL.

Normal hemoglobin levels are different for men and women:

  • Men: 14 to 17.5 g/dL
  • Women: 12.3 to 15.3 g/dL

What Causes Anemia?

Anemia has many causes, and people with leukemia can have more than one reason for having anemia. Some people, including women, adults over age 65, and those taking blood-thinning medications are more likely to develop anemia, regardless of whether they have leukemia.

Leukemia

All types of leukemia can cause anemia. When leukemia is in the bone marrow, the cancerous cells can crowd out healthy cells and lead to fewer red blood cells being produced.

Cancer Treatment

Leukemia treatments, such as chemotherapy or radiation therapy, can also cause anemia. These treatments can suppress bone marrow function, which then leads to anemia.

Nutritional Deficiency

Deficiencies in nutrients such as iron, vitamin B12, or folic acid can also lead to anemia. These nutrients are required for the production of healthy red blood cells.

Kidney Disease

If someone with leukemia also has decreased kidney function, this could be another cause of anemia. The kidneys play an important role in maintaining normal hemoglobin levels. They release a hormone called erythropoietin, which tells the bone marrow to make red blood cells. When the kidneys don’t function well, they can’t send this hormone signal to the bone marrow.

How Is Anemia Treated?

In mild cases, anemia may not require treatment. But if anemia is causing bothersome or dangerous symptoms, it may need to be treated. Because anemia can be caused by a variety of factors, there are many treatment options. Determining the cause and best course of treatment can help someone with leukemia feel their best.

Medications

A class of medications called erythropoiesis-stimulating agents (ESAs) may be used to treat anemia. ESAs are a human-made form of erythropoietin, the naturally occurring hormone used by the kidneys to stimulate red blood cell production.

Nutritional Supplements

If part of the cause of anemia is due to a nutritional deficiency, supplementing those nutrients can improve the anemia. Folic acid can be replaced with a daily oral pill. Iron can be replaced with oral supplements or through intravenous iron infusion. Vitamin B12 can be supplemented via pills or by injections. Always discuss with your doctor before trying a new nutritional supplement.

Eating a diet that contains these nutrients can also be helpful to prevent or treat any nutritional deficiencies. Some foods that contain these nutrients include:

  • Red meats
  • Green leafy vegetables
  • Beans
  • Enriched bread
  • Enriched cereal
  • Broccoli

Some members of MyLeukemiaTeam report feeling better after beginning doctor-ordered supplements. One member wrote, “When I got anemia, the doctor ordered prescription iron and B12, which has helped the tiredness.”

Blood Transfusion

If hemoglobin levels are significantly low, a blood transfusion may be necessary. Every cancer care team may have a different threshold for when a blood transfusion is needed. Part of the decision may be based on how severe anemia symptoms are and if a blood transfusion may help. During a blood transfusion, red blood cells from a donor are administered intravenously.

Members of MyLeukemiaTeam report feeling better after blood transfusions. “I have had three blood transfusions because of anemia,” wrote one member. “Didn’t know I was sooo tired until after I wasn’t!”

In severe cases when ESAs, nutritional supplements, and blood transfusions are not effective enough in keeping hemoglobin levels up, some members have required advanced care. “I was hospitalized for anemia when my hemoglobin took a dive down to 3.7 at its lowest,” shared one MyLeukemiaTeam member.

Talk With Others Who Understand

MyLeukemiaTeam is the social network for people with leukemia. On MyLeukemiaTeam, more than 9,900 members come together to ask questions, give advice, and share their stories with others who understand life with leukemia.

Are you living with anemia and leukemia? Share your experience in the comments below, or start a conversation by posting on your Activities page.

All updates must be accompanied by text or a picture.
Todd Gersten, M.D. is a hematologist-oncologist at the Florida Cancer Specialists & Research Institute in Wellington, Florida. Review provided by VeriMed Healthcare Network. Learn more about him here.
Julie Scott, ANP-BC, AOCNP is an adult nurse practitioner with advanced practice oncology certification, based in St. Louis, Missouri. Learn more about her here.

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