Managing Low Red Blood Counts

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Quick summary

Fatigue is one of the biggest complaints of cancer patients, and one of the most common causes is anemia, which occurs when chemotherapy or radiation cause red blood cell count (RBC) to drop. Here's how to help someone cope -- and feel better -- when his RBC is low, and when to seek further treatment.


How to help a cancer patient cope with a low red blood cell count


Help a cancer patient get more rest when red blood counts are low. Red blood cells contain hemoglobin, which circulates oxygen throughout the body. When hemoglobin is low, the condition is known as anemia, and it causes extreme fatigue.

Also, because the amount of oxygen being carried in the blood is lower, the patient may feel breathless, faint, and dizzy. If he doesn't acknowledge this fatigue and gets overtired, he can become quite ill. So it's important to encourage lots of rest, and enlist help to make sure he gets it.

If the person you're caring for, like many older folks and people in pain, is having trouble sleeping at night, try to schedule the day so he can take naps. If he's a coffee or tea drinker, he might have to limit caffeinated drinks to first thing in the morning so he can relax and nap later on.

Prepare iron-rich meals to fight anemia. Red meat and spinach, along with other dark-colored greens, are the best sources of iron. Of course there's also always liver, if the patient likes it. The doctor may recommend that he take an iron supplement as well, which can cause constipation. If he does become constipated, discuss this with the doctor and ask her to recommend a nonconstipating iron supplement.

It's also important to make sure the patient is getting enough folate and vitamin B-12, as these nutrients support the body's production of red blood cells. Talk to your doctor about whether he should take folic acid, B vitamins, or both.

Take precautions against dizziness when red blood counts are low. Standing or sitting up suddenly can bring on a bout of dizziness when the cancer patient's RBC is low, so suggest that he change positions slowly. In particular, it helps to have him sit on the edge of the bed for a few minutes before standing up.

While his RBC is low, he'll need to avoid doing anything that involves climbing or balancing, as the dizziness could lead to a fall. (No ladders, under any circumstances!) If there are dishes, food, tools, or other supplies stored in high cupboards that he usually uses a chair or stepladder to reach, help him move them into a lower cupboard.

Make a to-do list, then delegate like crazy. As a caregiver, one of the tasks that's going to fall squarely on you is to help the person you're caring for prioritize and delegate. That's because when someone is anemic, he's going to feel tired and unable to do everything he wants to do.

Sit down with him and make an exhaustive list of everything he feels he needs to get done. Start with daily tasks like getting dressed, eating, attending to bills and correspondence, and then move on to his "bigger picture" to-do list.

Next, talk about how you might enlist others to help get some of it done, so his expectations for himself aren't so high. For example, if he struggles with the fact that he used to make needed repairs around the house, he may get up every morning with plans to caulk the bathtub or clean out the gutters -- then end the day frustrated and grumpy because he didn't have the energy to tackle the job. You can try to find a handyman who'll handle each chore your friend or relative wants done. That way, he can feel like he's gotten something accomplished at the end of the day, without tiring himself out.

More ways to help manage low red blood counts

When to ask a cancer patient's doctor to treat extreme fatigue due to anemia


If the person's hemoglobin level drops below eight, or if he's so fatigued that he's not getting up and about very much, talk to the doctor about more aggressive treatment. There are two possible treatment options for low RBC: growth factors and transfusions.

Growth factors. These hormones, made by the kidneys, stimulate the bone marrow to produce more red blood cells. Low red blood cell count can be treated with injections of erythropoietin (EPO), also called epoetin and darbepoetin (brand names Procrit, Aranesp).

Growth factors can cause side effects, including high blood pressure, blood clots, rashes, and flu-like symptoms, so the doctor may hesitate to prescribe them. Unfortunately, growth factors have recently been linked to long-term health concerns, including kidney failure and shorter survival times for certain advanced cancers. So the patient, his doctor, and you will need to weigh the short-term benefit of helping him have more energy against this risk of rare side effects.

If your friend or relative does take Procrit or Aranesp, you can expect him to feel significantly better in four to six weeks, maybe even sooner. Iron has been found to help growth factors work better, so if the doctor prescribes growth factor injections, be sure to talk to her about iron supplementation as well.

Transfusions. If the doctor doesn't think growth factors will work, or if the patient has taken them and had trouble with side effects, or if the doctor wants treatment to take effect immediately, she can recommend a transfusion. (Transfusions are less common now than they were in the past because growth factors are usually tried first.) The advantage of a transfusion is that it will make the person you're caring for feel better right away.

Transfusions can also help with types of cancer, such as leukemia, that affect the body's ability to produce red blood cells. There are few side effects to having a transfusion, now that blood products are carefully screened. However, because plasma is a foreign substance that's introduced into the patient's body, his doctor will monitor him carefully to make sure he doesn't have a reaction.

Melanie Haiken

Melanie Haiken discovered how important it is to provide accurate, targeted, usable health information to people facing difficult decisions when she was health editor of Parenting magazine. See full bio