Anemia and Cancer

30 Oct

Written By

Anemia and Cancer

Anemia (lower-than-normal amount of healthy red blood cells) can be a complex issue, and it is wise to have the help of your doctor to investigate the root cause of the issue.

There are many factors that contribute to anemia in cancer patients such as the type and extent of malignancy, treatments (conventional, how frequent, type), patient age, other medical issues and other medications.
And, as is the case with many factors, timing, previous labs readings, rapidity of onset and other blood lab indicators are important.

This summary is for informational purposes only and does not constitute medical advice. Please consult with your physician about your issues.

1. Is it iron deficiency?
First step in figuring it out would be an assessment of possible blood loss. Even heavy menstrual periods over time can cause significant blood loss. Other causes of blood loss can be rectal bleeding or black or bloody stools, bloody discharge and tumor bleeding/seeping. Don’t discount “a little bit of blood” over time. Given enough time (of bleeding) the anemia of this type is usually an iron deficiency. Inadequate iron intake can potentially be the reason for iron deficiency but that takes a relatively long time.

So, for an iron deficiency to develop you’ll either have to have blood loss or inadequate iron intake or absorption ongoing for a while. Though that can happen, it may not be THE reason for the anemia, so treating with iron supplement may be counterproductive.

Assessment of iron deficiency specifically would be as follows:
-       Ferritin in cancer or indeed any chronic disease especially with an inflammatory component is unreliable and should not be used in assessing iron status. It is considered an acute phase reactant which reflects inflammation in the system. This is true for elevated ferritin readings, these are unreliable. If ferritin is LOW, it pretty accurately depicts iron deficiency.
-       In either case it would be prudent to confirm iron status. The most reliable lab may be % iron saturation (also called % FE sat). This may need to be ordered specifically on an iron panel. Make sure the panel has this information.
- Low % FE saturation indicates iron deficiency, even if ferritin is high.
-       Adding iron supplements if the anemia is not due to iron deficiency has been reported to stimulate cancer growth

2. Can Hemolysis be the cause of anemia?
Another possibility for anemia in cancer is hemolysis or the breaking up of red blood cells. This can be a very dangerous and often rapid process and needs the attention of your physician. It is not a common cause, and mostly seen in hematologic cancers, but can be serious. In this case, a lot of the time, the Hemoglobin can drop significantly in a short period of time. Because the blood cells break up but release their content into circulation, iron is retained and does not usually cause iron deficiency. Hemolysis can also be an autoimmune problem.
Labs usually used for hemolysis are an elevated LDH (that can have multiple other causes), an elevated bilirubin and decreased haptoglobin and often an elevated reticulocyte count (signifying new red blood cell growth).

3. What are other deficiencies that can cause anemia?
In an anemia workup, B12 and Folate levels are also done, but in my experience Folate deficiency is uncommon in cancer patients. B12 deficiency is more common, especially in older people who lose the ability to adequately absorb B12 vitamins. Although “normal” levels are indicated as around 300 as reported on your lab results, a lot of integrative and naturopathic practitioners like to see it at 500 and above. If you have a lack of ability to absorb B12, the best way to supplement is either IM or SQ injections or sublingual (SL) supplements.
Often B12 or Folate deficiency anemia is a macrocytic anemia (high MCV).

4. Cancer treatments, traditional chemotherapy as well as conventional immune therapies can result in anemia.
This is usually just a “stop growth” anemia, just as these drugs stop cancer, white blood cells and platelets, it does the same to red blood cells. And each subsequent treatment usually drops the counts more, although most often they recover after therapy is complete. Sometimes however it can depress the bone marrow permanently and that is hard to treat. Conventional medicines boost white blood cells or red blood cells with growth factors (peg filgrastim for WBC, erythropoietin for RBC f ex) but take caution with these growth factors (read the package insert of the drug if you’re told you need it – it’s good to be informed).

5. Thyroid issues
Thyroid issues can also cause anemia - both hyperactive and hypoactive thyroid and is also usually a long-term onset. This can be evaluated with thyroid labs. For example macrocytosis (large red blood cells) can among other things be an indicator of low thyroid.

6. Other Causes
Lead poisoning, chronic kidney disease (the hormone erythropoietin responsible for red blood cell growth is produced by the kidneys), inflammatory and autoimmune diseases (ulcerative colitis, rheumatoid arthritis), sickle cell disease, thalassemia. In these cases you will need a blood specialist/ hematologist to diagnose these.

7. Bone Marrow Issues
Bone marrow issues can also cause anemia but usually WBC and platelets are also affected, but not always. Examples are aplastic anemia (bone marrow won’t grow RBC, leukemias and other bone marrow diseases). Diagnoses of these issues usually require a bone marrow biopsy (if that is necessary, ask for conscious sedation to have that done, my opinion). And cancer treatments can also cause permanent bone marrow issues.

8. Other lab indicators that help elucidate the problem of what kind of anemia:
- MCV on your lab report. Severe iron deficiency anemia usually shows a low MCV, whereas B12, Folate or thyroid issues (also lead) often show a high MCV. This is not always the case, however, especially in “mixed” anemia such as B12 AND iron deficiency.

- Reticulocyte count – a special order lab. This looks at nucleated (with a cell nucleus) red blood cells. Mature red blood cells have lost their nucleus and so nucleated red blood cells indicate new growth and can rule out intrinsic bone marrow issues

- Are your other blood cells normal or affected? Iron deficiency anemia usually does not affect the other blood cells. Severe B12 deficiency can affect all, and cause neuropathy for example.

- Look at a trend. When exactly did the anemia occur. Did it come on slowly or can it be at a certain time or onset related to a treatment or drug including some supplements. For example artemisia products are well know to cause anemia, actually via iron deficiency, because that’s how this herb works (uses iron to kill cancer cells). It is therefore important to pulse Artemisia products in the long term although if given IV and needing a good effect fast it can be used for a short time without pulsing. Long term Artemesia treatment should also be monitored for anemia and iron deficiency (% Fe sat).

Radiation therapy, especially to the pelvis where a lot of blood cells are made, can also cause anemia and often pancytopenia (low RBCs, WBCs, platelets). Those are hard to treat. Replacement of the bone marrow by overwhelming cancer or very significant bone metastases can also cause anemia and would ideally be treated by treating the cancer. Both radiation or cancer effect most often shows the other blood counts to be low as well (pancytopenia)

In case of immune related anemias, such as autoimmune issues, often corticosteroids are used short-term to boost especially WBC but also RBC and platelets.

As you can see, anemia is a pretty complicated subject, and cancer patients often have multiple issues as mentioned above. It is truly best to have a medical or naturopathic professional assess your anemia and suggest testing and therapy.

Want to Book a consultation with our Integrative Specialists? Call 09 600 2759

Book NowDisclaimer: This website does not provide medical advice. The information including text, graphics, and images, are for informational purposes only. No material on this site is intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified healthcare provider with any questions you may have regarding a medical condition or treatment.

Anemia and Cancer

Anemia and Cancer

Read More...

Anemia and Cancer

Cancer Surgery – If you are faced with surgery, what you need to ask first

Could Beetroot Help Fight Cancer?

Anemia and Cancer

Anemia and Cancer

Read More...

Anemia and Cancer

Cancer Surgery – If you are faced with surgery, what you need to ask first

Could Beetroot Help Fight Cancer?

Breast Cancer Medications Funded in Australia but not New Zealand

High Dose Vitamin C - Combination Therapies for Cancer Patients