Anemia/Chemo

[LLVV]

My dad is getting ready to be discharged from the hospital because his pain management plan has allowed his pain to become somewhat controllable. He is starting to walk again although with difficulty. He learned today that he is dangerously anemic (not sure which exact type of anemia he has or which RBC counts are off). He is being given a transfusion and his discharge date will be tomorrow morning after radiation because the hospital didn't start the transfusion until tonight. He didn't want to leave at midnight.

Does anemia prevent you from getting chemo? I know that low WBC and platelet counts will but I'm not familiar with anemia and how it interplays with chemo. He was anemic prior to starting chemo so his colon tumor is probably bleeding. However, can chemo induce anemia? I know that thrombocytopenia is what low platelet counts are called but can low platelets = anemia? My dad originally told my mom that his platelets were low and that he needed a transfusion but the head nurse told my mom that he's actually anemic and his anemia is so bad that he's at risk for passing out. I think he was confused due to information overload but now I'm wondering.

[LLVV]

I should also add that he's undergoing daily radiation treatments of 250 rads.

Does anyone know how to convert rads into GYs. I don't understand the rads measurement but I do understand GYs. I'm just curious what his complete GY dose will be.

[SkiFletch]

The absoloute statement that CRC chemo does NOT cause anemia isn't exactly true, however it is very unlikely to do so in most patients. Thrombocytopenia is in fact a very common side effect of chemo although rarely do platelets get so low that a transfusion is required. If the nurse is saying his anemia makes him likely to pass out, its low RBC and/or Iron deficiency that is the problem that is requiring him to get a transfusion. Different institutions have different requirements, but most will transfuse when hemoglobin gets below 9 or 10. You're right, it's most likely the case that his tumor is necrotic, bleeding, and is the root cause of the anemia. I can't say what your dad's oncologist will say about anemia and witholding treatment, but I was given chemo with an HgB in the 10 range. Through some proper diet I was able to get my HgB to rise throughout chemo. If your dad still has a bleeding tumor, rising might be out of the question, but maintaining it could be possible. Eggs (with yolk) and orange juice every morning were my weapon of choice. Whatever iron rich food he eats, make sure he gets vitamin C with it, as that increases absorption rates.

[Phuong]

I was very close to missing a treatment or two because of my anemia/iron deficiency. They tried to put me on Ferrus Sulfate and then Ferrus Glutinate, but both caused severe stomach pains. I was switched to neupogen shots on my off weeks, but I didn't have platelet involvement. Those shots were painful financially - $500 per shot AFTER insurance! If that's the way your dad has to go, I suggest shots in the stomach. Sounds horrible, but it's less painful than the back of the arm. Stick quick with the needle, then VERY slow on the injection. Piece of cake. Good luck and good health to your Dad!

[waw4]

From what I understand, chemotherapy can/is likely to interfere with red blood cell production, which can lead to anemia. There are various types of anemia, the differing types having different causes; but the most likely cause of anemia with chemo patients is the chemo interfering with red blood cell production in the bone marrow.

There are various remedial responses to anemia - including iron supplements, synthetic hormone injections to increase red blood cell manufacture (Procrit), and transfusion. As I understand it, transfusion is sort of a last resort approach in response to more significant anemia.

Ed Uthman, a pathologist, has a very informative site (and book) on anemia at:
http://web2.airmail.net/uthman/blood_cells.html

mg = milligrams, dL = deciliter (1/10th of a liter)

He states anemia is primarily defined by hemoglobin levels and, for males, a hemoglobin level of less than 12mg/dL is the definition of anemia. Mild anemia would see hemoglobin levels at 10-to-12mg/dL; moderate anemia hemoglobin levels at 7-to-10mg/dL; and severe anemia hemoglobin levels below 7mg/dL.

My onc said Procrit would not be considered until hemoglobin levels fell below 10mg/dL. I would imagine transfusions would not be considered until hemoglobin levels fell below 7mg/dL. If your Dad is at these levels, he would likely be very fatigued most of the time.

Your onc's office could get all the blood lab reports from the hospital and you could see the history of his hemoglobin levels. You can also get printouts from all the blood tests done at the onc's office.

Long term bleeding from pre-existing colon cancer would lead to a loss of iron, which could be a contributing factor to anemia. There are 2 types of iron tests which can be run with the blood labs - one which measures transport iron and one which measures storage iron.

Iron supplements probably deserve their own comment, or maybe their own thread. You should get the iron blood level tests run to see if iron levels may benefit from supplements.

If I were you, I would find out how severe is the anemia and I would do that by looking at the hemoglobin levels on the most recent blood test.