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Anaemia In Oncology Rehab

Anaemia is a common symptom in cancer and many chronic diseases commonly causing fatigue, dizziness, due to a postural drop, and sometimes delirium.



What problems are caused by anaemia?


Haemoglobin is needed to carry oxygen and if you have too few or abnormal red blood cells, or not enough haemoglobin, there will be a decreased capacity of the blood to carry oxygen to the body's tissues.

When a person has a lower red blood count than is normal, their body has to work harder to get enough oxygen to the cells. A low red blood cell (RBC) count can cause a variety of symptoms and health complications, including fatigue, weakness, dizziness and shortness of breath, among others.


Image of red blood cells

What does severe anaemia feel like?


Anaemia is a condition in which you lack enough healthy red blood cells to carry adequate oxygen to your body's tissues. Having anaemia, also referred to as low haemoglobin, can make you feel tired and weak.


What is most likely to cause anaemia?

The most common cause of anaemia is low levels of iron in the body. This type of anaemia is called iron-deficiency anaemia. Iron is needed to form haemoglobin, part of red blood cells that carry oxygen and remove carbon dioxide (a waste product) from the body. Iron is mostly stored in the body in the haemoglobin. However, iron-deficiency anaemia is just one type.


What is the most common cause of iron deficiency?


Bleeding is the most common cause of iron deficiency.


How does anaemia look and feel?


You will often look pale and feel weak.

Dark circles under your eyes are common. They are most often due to lack of sleep but they could suggest other health issues including anaemia as iron deficiency can prevent your blood from carrying sufficient oxygen to your eye tissues.


How is anaemia diagnosed?


Your doctor is likely to ask you about your medical and family history, perform a physical exam, then blood tests, complete blood count (CBC) to count the number of blood cells in a sample of your blood, and a test to determine the size and shape of your red blood cells.

Then the cause will be investigated, whether due to bone marrow infiltration or blood loss, to establish whether it can be corrected.


What are the treatments for anaemia?


1/ Erythropoietin, also known as EPO, a hormone that the kidneys produce to stimulate production and maintenance of crucial red blood cells. The hormone does this in two ways, it stimulates bone marrow cells to produce red blood cells. Then, it works to protect the cells from destruction once they are in the body. The down side is it is expensive and slow acting when used as a treatment for anaemia.


2/ Blood transfusion.


3/ Iron tablets.


Each individual is assessed to establish whether the stress of treatment is worth the benefit. 50% look better after treatment. 10-20% have a symptomatic improvement.


Is being anaemic serious?


Anaemia is a condition where you don't have enough healthy red blood cells, to carry oxygen throughout your body. Anemia can be temporary or long term (chronic). In many cases, it's mild, but anemia can also be serious and life-threatening.


What foods should you avoid if you are anaemic?


Don't eat iron-rich foods with foods or beverages that block iron absorption:

  • tea and coffee.

  • milk and some dairy products.

  • eggs.

  • foods that contain tannins, such as grapes, corn, and sorghum.

  • foods that contain phytates or phytic acid, such as brown rice and whole-grain wheat products.

  • foods that contain oxalic acid, such as peanuts, parsley, and chocolate.

  • foods high in oxalates, and foods high in calcium.

What foods should you eat if you are anaemic?


Choose iron-rich foods:

  • Red meat, pork and poultry.

  • Seafood.

  • Beans.

  • Dark green leafy vegetables, such as spinach.

  • Dried fruit, such as raisins and apricots.

  • Iron-fortified cereals, breads and pastas.

  • Peas.

Blueberries contain iron, phosphorous, calcium, magnesium, manganese, zinc, and vitamin K. Each of these is a component of bone. Adequate intake of these minerals and vitamins contributes to building and maintaining bone structure and strength.


Image of blueberries

Berries are not a strong carrier of iron but they act as an active iron absorber. Strawberries, blueberries, cranberries or blackberries are all good sources of vitamin C. Consumption of any type of berries increases the absorption rate of non-heme iron.


Citrus fruits, including oranges and grapefruits and contains large amounts of vitamin C. Kiwi is a nutrient-dense fruit that is rich in vitamin C.

Guava contains fiber, potassium, and vitamin A.


Apples are with Vitamin C and iron and are great for reducing risk of anaemia, and improving haemoglobin levels, and healthy blood flow in the body.


Bananas have a high enough iron content that is suitable for people with anaemia. Consume 2 bananas (±100g) every day routinely to overcome the deficiency of red blood cells or anaemia.


Prune juice, 1 cup (240 mL) delivers 17% of your daily iron needs.

While drinking prune juice could help you meet your daily iron needs, it's important to note that non-heme iron isn't as bioavailable as heme iron or the iron found in supplements.


Apple Cider Vinegar, a mixture of lemon, honey and apple cider vinegar may be taken every morning in empty stomach. This is an effective home remedy.


Can drinking water help with anaemia?


Iron fortification of household drinking water can be a simple and effective alternative to deal with iron deficiency and iron-deficiency anaemia in less developed areas.


How do I stop anaemia fatigue?


Reduce your intake of caffeine, sugar and alcohol to keep your energy levels up. Avoid dehydration as this can add to your fatigue. Drink plenty of water during the day. Try incorporating light exercise in your day, as there is evidence that regular exercise can help combat fatigue.



Is walking good for anaemia?


If you have anaemia, exercise doesn't have to be long to be beneficial. Shorter workouts, such as walking around the block or climbing stairs, add up and contribute to your weekly physical activity goal.


Does stress cause anaemia?


Sustained stress is another cause of anaemia. Excessive stress hinders the manufacture of hydrochloric acid in your body, which is very important for the integration of iron and proteins. The deficiency of iron is equal to lack of haemoglobin and thus, anaemia.


Image of a Yoga meditation pose to help reduce stress

Can lack of sleep can cause anaemia?


Short sleep time could lead to low haemoglobin concentration, and disturbed sleep also increases the risk of anaemia.


Is anaemia cancerous?

There are several types of anaemia, however, iron-deficiency anaemia is most often linked to cancer. Iron-deficiency anaemia is caused by a lack of healthy red blood cells in the body.


Anaemia Signs and Symptoms

As anaemia worsens, your body can experience visible physical changes, your skin could become pale, your nails brittle and cuts may take longer to stop bleeding. Other symptoms associated with anaemia include, shortness of breath and irritability.


Can being anaemic affect your memory?

Anaemia, or a low red blood cell count, is associated with an increased risk of mild cognitive impairment, a form of memory loss that often precedes Alzheimer's disease.


Does anaemia make you cold?


Anaemia occurs when there are not enough healthy red blood cells to carry oxygen to your body's organs. As a result, it's common to feel cold and symptoms of tiredness or weakness.


Does anaemia get worse at night?


Oxygen deprivation causes them to work overtime and cause fatigue, weakness, severe cramps, and restless leg syndrome (RLS), which may contribute to insomnia. Anaemic patients may feel a crawling or itchy sensation in the feet and legs, which can worsen at night.


How much sleep does an anaemic person need?


One of the best ways to manage anaemia-related fatigue is to try and get sufficient sleep. However, you will want to avoid sleeping too much because that will add to fatigue. Instead, aim to get seven to nine hours of sleep every night.


Image of a Yoga Corpse Pose to help to relax improving sleep

Is it OK to exercise with anaemia?


If you have chronic anaemia, exercise may leave you easily fatigued and short of breath. Because your blood is iron deficient and carries less oxygen to working muscles, moderate physical activity can feel significantly more strenuous.


How long does it take to get over anaemia?


With treatment, most people recover from iron-deficiency anaemia in 2 to 3 months. You may need to take iron supplements for several months longer, though, to build up your reserves of iron.


What will happen if anaemia is not treated?


Anaemia if not treated for a long period can lead to serious complications including heart failure, severe weakness and poor immunity.


Does anaemia affect the immune system


Research has shown iron deficiency anaemia can affect your immune system, the body's natural defence system. This increases your vulnerability to infection.


Why do cancer patients develop anaemia?


Anaemia is a common condition of cancer patients. This is because cancers cause inflammation that decrease red blood cell production. In addition, many chemotherapies are mylosuppressive, meaning they slow down the production of new blood cells by the bone marrow. Anaemia is also caused by kidney disease.


The main cause of anaemia in cancer patients is twofold, the cancer itself and the therapy used for the management of the cancer. Cancer cells that infiltrate the bone marrow can directly suppress haematopoiesis and cause anaemia.


With colon cancer or blood-related cancer such as leukaemia or lymphoma, anaemia may be one of the first signs of the disease.


Colorectal cancers can often bleed into the digestive tract. Sometimes the blood can be seen in the stool or make it look darker, but often the stool looks normal. But over time, the blood loss can build up and can lead to low red blood cell counts (anaemia).


What type of cancer causes anaemia?


The cancers most closely associated with anaemia are cancers that involve the bone marrow. Blood cancers like leukaemia, lymphoma, and myeloma interfere with or destroy the marrow's ability to make healthy blood cells. Other cancers that spread to the bone marrow can also cause anaemia.


Anaemia is often the first symptom of multiple myeloma. At least 60%-70% of patients with MM have anaemia at the time they are diagnosed, and most will experience it during the course of the disease. If your physician suspects you have anaemia, your blood will be drawn for lab tests.


Can lung cancer cause severe anaemia?


Anaemia has a high prevalence in patients with lung cancer. Its frequency and severity depend on tumour stage, duration of disease, and previous and current treatment. Anaemia affects the health-related quality of life and impacts prognosis and outcome of therapy.


Is pernicious anaemia associated with gastric cancer?


Pernicious anaemia, can be caused by certain autoimmune conditions, as well as by some types of stomach surgery. Along with anaemia (having too few red blood cells), people with this disease have an increased risk of stomach cancer.


How does pernicious anaemia affect the stomach?


In pernicious anaemia, the body makes antibodies that attack and destroy the parietal cells. These cells line the stomach and make intrinsic factor. Why this autoimmune response occurs isn't known. As a result of this attack, the stomach stops making intrinsic factor.


What is chemotherapy induced anaemia?


Chemotherapy-induced anaemia (CIA) is a consequence of malignant invasion of normal tissue leading to blood loss, bone marrow infiltration with disruption of erythropoiesis, and functional iron deficiency as a consequence of inflammation.

Chemotherapy attacks rapidly dividing cells, including the cells that eventually form red blood cells.

Chemotherapy can also cause iron deficiency due to a reduced appetite and poor nutrition, gastrointestinal mucosal damage that results in blood loss, or the release of chemicals known as cytokines.


How is chemo induced anaemia treated?


Current practices to treat CIA include packed red blood cell transfusions, erythropoietin stimulating agents (ESAs), and iron supplementation. The goal of red blood cell transfusion is to maintain or improve the oxygen-carrying capacity in the blood to facilitate oxygen delivery to tissues.


How can you prevent anaemia during chemo?


At home combat anaemia or fatigue by:

  1. Get plenty of rest. Sleep more at night and take naps during the day if you can.

  2. Slow down. ...

  3. Ask for help. ...

  4. Eat a well-balanced diet, including plenty of calories and protein. ...

  5. Take snacks with you and eat when you feel like it.

What foods are good for anaemia during chemo?


Eating enough folate-containing foods may help to prevent anaemia. The best sources of folate are lentils, pinto beans, garbanzo beans, spinach, black beans, navy beans, kidney beans, collard greens, turnip greens, and lima beans.


How long does anaemia last after chemotherapy?


The best way to cope with anaemia 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 anaemia is one cause of fatigue that is very treatable and it will usually begin to improve a few weeks after completing chemotherapy.


How does anaemia affect the lungs?


With anaemia, the lungs overcompensate in order to bring in more oxygen, causing breathing difficulties. Low levels of haemoglobin prevent adequate oxygen from reaching the brain. Blood vessels swell, blood pressure drops, and it can result in headaches, neurological issues, and vertigo.

When do you need a blood transfusion for anaemia?


Some doctors believe that hospital patients who fall below 10 g/dL should get a blood transfusion. But recent research found that: Many patients with levels between 7 and 10 g/dL may not need a blood transfusion. One unit of blood is usually as good as two, and it may even be safe.


Can anaemia be cured?


Doctors focus on treating the underlying disease. If symptoms become severe, a blood transfusion or injections of a synthetic hormone normally produced by your kidneys (erythropoietin) might help stimulate red blood cell production and ease fatigue.


What organs are affected by anaemia?

Severe anaemia can cause low oxygen levels in vital organs such as the heart, and can lead to heart failure.


How does anaemia affect the brain?

Severe anaemia, or low haematocrit, has been associated with cognitive dysfunction, impaired cerebral vascular regulation, neurological injury, and increased mortality, which suggests that the brain is vulnerable to anaemia-induced injury.


Is anaemia terminal?


Many cases of anaemia stem from an iron deficiency. These types of anaemia are easily treatable. However, aplastic anaemia starts with a bone marrow problem and it is not caused by iron deficiency. The condition is rare, but it can be fatal if left untreated.


Is aplastic anaemia a form of blood cancer?


Aplastic anaemia is not cancer, but it can be caused by common cancer treatments such as radiation and chemotherapy. Aplastic anaemia causes your bone marrow to stop making either one, two, or all three types of new blood cells: red cells, white cells, and platelets.


When should you suspect you have Anaemia?


When exercise fatigue and/ or breathlessness are greater than normal, and resting heart rate is higher than normal.


With delirium, exercise fatigue and breathlessness medical attention should be sought.


Image of a Cancer Rehab Physiotherapist supported exercise program

What changes & exercise adaptations should be made with anaemia?


Resting heart rate should be regularly checked with medical advice sought on significant rise.


If you are diagnosed with anaemia and planning to exercise you will require a management strategy. Make sure you are cleared by your doctor before commencing exercise and follow any precautions.


Be attentive to changes and make sure you are in a safe environment with support of a professional or supportive, aware companion to minimise injury if you experience delirium, dizziness or feel faint during sessions.


Tailor your sessions on the day, monitoring your symptoms, including fatigue, breathlessness and dizziness.


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