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Bone Marrow Suppression

Low Red Cell Blood Counts

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© American Cancer Society 2010

Not having enough RBCs is called anemia.

Doctors use 2 measurements to determine if you have enough RBCs.

  • The red pigment in RBCs that carries oxygen is hemoglobin (HGB). If there are not enough RBCs, the blood hemoglobin concentration will be less than its usual range of 12 to 16 grams per deciliter (g/dL) in women or 14 to 18 g/dL in men.
  • Hematocrit (HCT) is the percentage of total blood volume occupied by RBCs. The normal range is between 37% and 52%. Levels are usually higher for men than for women.

With anemia, you may have the following symptoms:

  • Extreme tiredness called fatigue
  • Pallor or paleness of the skin and mucous membranes (like the mouth and gums)
  • Dizziness
  • Headaches
  • Irritability
  • Shortness of breath, especially with exertion (walking, going up steps, etc.)
  • Low blood pressure
  • A rise in heart rate or breathing rate (or both)

Anemia caused by chemotherapy is usually temporary. But blood loss caused by surgery or by the cancer (a common occurrence with colorectal cancers, for example) can make anemia even worse.

If the symptoms are severe, blood transfusions can correct the RBC levels until the bone marrow is healthy enough to replace worn-out RBCs. Because blood transfusions have some risks, doctors use this procedure only if there are serious signs and symptoms, such as severe shortness of breath and/or very low RBC counts (typically less than 8 g/dL). Other factors will also affect this decision. For example, people with heart or lung diseases are more sensitive to anemia and may have severe symptoms even though their hemoglobin levels may be higher than 8 g/dL.

An option for some people with anemia caused by chemotherapy is a growth factor called erythropoietin (also called EPO, epoetin, Procrit®, or Epogen®). This drug is only used in patients whose treatment is not expected to cure their cancer. It’s a man-made version of a naturally occurring growth factor that prompts bone marrow cells to make more RBCs. It can relieve symptoms of anemia and reduce the need for blood transfusions, but it usually takes at least 2 weeks to start working.

Procrit is generally given once a week by injection under the skin (SQ) until the hemoglobin level rises (usually to between 10 and 12 g/dL). A newer, longer- lasting form, called darbepoetin (Aranesp®), is given weekly, but might be given every 2 to 3 weeks in some patients. Again, it is not used in people whose treatment is expected to cure their cancer.

Because these growth factors may raise the risk of blood clots, blood counts must be watched closely at follow-up appointments. If you notice shortness of breath getting worse, pain or swelling in your legs, dizziness or fainting, higher blood pressure readings, or fatigue, call your doctor right away. Get help right away if you have chest pain, numbness, trouble walking or moving, or trouble speaking or understanding others.

Red blood cell growth stimulators were often used in the past to help patients avoid transfusions. Studies are now suggesting that these drugs may cause some cancers to grow or come back (recur). They may even lead to earlier deaths in some people. These effects were seen in studies that used these drugs to bring the hemoglobin up to normal (higher than 12). Because of these concerns, the FDA has warned against using this type of drug to get a high target hemoglobin. The FDA also decided that people whose chemotherapy is expected to cure their cancer shouldn’t get these drugs at all.

More information is available in the American Cancer Society document, Anemia in People With Cancer offsite link.

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