Symptom Management, Palliative Care, or Supportive Care to relieve side-effects is an important part of cancer care and treatment and should always form part of the overall treatment plan.

Anaemia means that there is an abnormally low level of red blood cells and occurs when the body is losing blood, is not making enough blood, or destroys red blood cells. Anaemia is very common in children with cancer, especially in those receiving chemotherapy treatments.

Red blood cells contain haemoglobin, an iron protein that gives red blood cells their characteristic colour; its primary function is to transport oxygen from the lungs to the body tissue all over the body.

When the level of red blood cells is too low, some parts of the body do not get sufficient oxygen and cannot work properly. Anaemia causes most people to feel tired or weak. The fatigue associated with anaemia can lower one’s quality of life and ability to cope with cancer and treatment side effects.

Signs and Symptoms

Relieving side effects is an important part of total cancer care and treatment, which is why you should discuss any symptoms your child is experiencing, new symptoms and changes in symptoms with their Oncology Team so that they can work out a regimen of palliative or supportive care for them.

People with anaemia may experience some of these symptoms:

  • Bleeding problems
  • Difficulty breathing or shortness of breath
  • Difficulty concentrating
  • Difficulty staying warm
  • Dizziness or fainting
  • Fatigue
  • Headaches
  • Insomnia
  • Muscle weakness
  • Pale skin or lips
  • Rapid or irregular heart beat and occasional chest pain


Red blood cells are made in the bone marrow, the soft, spongy tissue found inside larger bones. Erythropoietin, a hormone made in the kidneys, tells the body when to make more red blood cells. This means that anaemia could occur if the kidneys or bone marrow are damaged.

  • Chemotherapy is one cause of anaemia. The effect of chemotherapy on the bone marrow is usually only temporary though, and any anaemia should improve a few months after chemotherapy is finished. Chemotherapy sometimes harms the bone marrow so it cannot make enough red blood cells. Chemotherapy with platinum drugs may harm the kidneys, lowering the production of erythropoietin.
  • Cancers that affect the bone marrow directly, such as lymphoma, leukaemia and multiple myeloma, or cancers that have spread to the bone or bone marrow may displace normal red blood cells, resulting in anaemia.
  • Radiation therapy to large areas of the body or to bones in the abdomen, chest, legs, or pelvis, can also damage the bone marrow, lowering its ability to make red blood cells.
  • Nausea, vomiting, and loss of appetite may result in a lack of the nutrients needed to make red blood cells, including iron, vitamin B12, and folic acid.
  • Excessive bleeding can cause anaemia if red blood cells are lost quicker than they can be replaced. This might happen from a tumour that is causing internal bleeding or after surgery.
  • The body’s immune system response to cancer cells can also cause anaemia, called anaemia of chronic disease.

Diagnosis and Treatment

A blood test that counts the number or percentage of red blood cells and measures the amount of haemoglobin in a person’s blood is used to diagnose anaemia

A blood value called the haematocrit is the percentage of red blood cells relative to the other cells and plasma in whole blood. The haemoglobin value is generally ⅓ of the haematocrit value.

Children with a specific type of cancer and those receiving cancer treatments known to cause anaemia should have regular blood tests, generally a complete blood count (CBC), to look for anaemia and other blood-related complications.

Treatment for anaemia depends on the symptoms and the cause of anaemia:

  • If the anaemia causes symptoms, the child with cancer may require a transfusion of red blood cells.
  • If the anaemia occurs as a result of chemotherapy, the doctor may treat it with erythropoiesis-stimulating agents that are forms of erythropoietin that are grown in the laboratory and work by telling the bone marrow to make more red blood cells. These drugs are usually given as a series of injections and can take up to four weeks to start working, but some of these drugs are associated with serious health risks.
  • If a lack of nutrients is the cause of the anaemia, the doctor may prescribe iron or folic acids pills or vitamin B12. Vitamin B12 is sometimes given as an injection if your child’s doctor is concerned about the vitamin being absorbed through the stomach. Eating foods high in iron such as red meats, dried beans or fruits, almonds, broccoli, and enriched breads and cereals may help, as will eating foods high in folic acid such as breads and cereals, asparagus, broccoli, spinach, and lima beans.