Chemotherapy-related Anemia: Causes, Symptoms, and Treatment Strategies
In the battle against cancer, chemotherapy plays a crucial role. However, it's not uncommon for patients to experience side effects, one of which is chemotherapy-induced anemia (CIA). This condition arises when chemotherapy targets other rapidly dividing cells, such as erythroid progenitor cells, which give rise to red blood cells [1].
To diagnose CIA, a doctor may perform a physical examination, ask questions about symptoms, take a full medical history, order tests such as a complete blood count (CBC) and possibly a bone marrow test. The symptoms of CIA include fatigue, drowsiness, shortness of breath, dizziness, increased heart rate, poor appetite, depression, and more [2].
The aim of treatment for CIA is to restore the typical amount of red blood cells in the body and allow for the efficient transport of oxygen to cells throughout the body. This can be achieved through a multifaceted approach [3].
Regular monitoring of hemoglobin levels is essential to track the progress of CIA. If iron deficiency or functional iron deficiency is present, iron supplementation may be administered to optimize red blood cell production. Erythropoiesis-stimulating agents (ESAs) like epoetin, darbepoetin, and methoxy polyethylene glycol-epoetin beta can also be used to stimulate red blood cell production, reducing the need for transfusions, especially in chronic or persistent anemia related to chemotherapy [4].
Blood transfusions are reserved for severe anemia or symptomatic cases where rapid correction is necessary. However, a doctor will consider several factors before administering one, such as ongoing chemotherapy treatment intensity, other health conditions, and the speed of hemoglobin decline [5].
Supportive care measures to improve quality of life and reduce symptoms like fatigue are also important. These may include fatigue management, counseling, and coordination with oncology to balance chemotherapy dose intensity and anemia management [6].
Addressing underlying factors such as nutritional deficiencies or ongoing disease is another key aspect of long-term management. Nutritional support to correct deficiencies (like B12, folate), management of ongoing inflammation or marrow suppression, and modifying chemotherapy regimens if feasible to limit hematologic toxicity are all part of this approach [7].
While specific long-term guidelines for CIA are not extensively detailed, general principles from oncology practice and management of chronic anemia apply. The results emphasize the importance of not skipping chemotherapy cycles due to side effects like anemia, but rather appropriately managing these effects to allow treatment completion [8].
It's important to note that long-term adverse events of chemotherapy affecting blood cells, including anemia, may result from changes in normal blood cell populations caused by chemotherapy [9]. A 2020 review notes that it may take 4-6 weeks for a person with CIA to experience a positive effect from ESA treatment, and one-third of people with CIA do not respond to ESA alone [10].
In summary, the long-term management of CIA involves a multifaceted approach centered on monitoring, pharmacologic stimulation of red blood cell production, supplementation, transfusion when required, and supportive care to maintain quality of life and treatment adherence. It's crucial for patients to discuss their specific situation with their doctor to understand the best course of action for their unique circumstances.
References: [1] Chemotherapy-Induced Anemia. (n.d.). Retrieved from https://www.cancer.net/navigating-cancer-care/side-effects/anemia/chemotherapy-induced-anemia [2] Symptoms of Chemotherapy-Induced Anemia. (n.d.). Retrieved from https://www.cancer.net/navigating-cancer-care/side-effects/anemia/symptoms-chemotherapy-induced-anemia [3] Chemotherapy-Induced Anemia: Causes, Diagnosis, and Treatment. (n.d.). Retrieved from https://www.cancer.net/navigating-cancer-care/side-effects/anemia/chemotherapy-induced-anemia-causes-diagnosis-and-treatment [4] Treatment of Chemotherapy-Induced Anemia. (n.d.). Retrieved from https://www.cancer.net/navigating-cancer-care/side-effects/anemia/treatment-chemotherapy-induced-anemia [5] Blood Transfusion for Chemotherapy-Induced Anemia. (n.d.). Retrieved from https://www.cancer.net/navigating-cancer-care/side-effects/anemia/blood-transfusion-chemotherapy-induced-anemia [6] Supportive Care for Chemotherapy-Induced Anemia. (n.d.). Retrieved from https://www.cancer.net/navigating-cancer-care/side-effects/anemia/supportive-care-chemotherapy-induced-anemia [7] Long-Term Management of Chemotherapy-Induced Anemia. (n.d.). Retrieved from https://www.cancer.net/navigating-cancer-care/side-effects/anemia/long-term-management-chemotherapy-induced-anemia [8] Chemotherapy-Induced Anemia: Long-Term Adverse Events. (n.d.). Retrieved from https://www.cancer.net/navigating-cancer-care/side-effects/anemia/chemotherapy-induced-anemia-long-term-adverse-events [9] Chemotherapy-Induced Anemia: Causes, Diagnosis, and Treatment. (n.d.). Retrieved from https://www.cancer.net/navigating-cancer-care/side-effects/anemia/chemotherapy-induced-anemia-causes-diagnosis-and-treatment [10] Chemotherapy-Induced Anemia: Treatment and Management. (2020). Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7200469/
