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Childhood cancer patients may experience a decrease in red blood cells, known as anemia. Certain treatments or a cancer that affects the bone marrow can cause this condition.

Red blood cells are cells that carry oxygen from the lungs to other parts of the body. People with anemia may feel tired and weak.


Causes of anemia include:

  • Chemotherapy – Chemotherapy can damage bone marrow. 
  • Radiation – Radiation of large areas of the body or to bones in the pelvis, legs, chest and abdomen can damage bone marrow.
  • Certain cancer types – Cancer of the bone marrow, including leukemia and lymphoma, can result in anemia.
  • Excessive bleeding – This condition may occur after surgery or if a tumor causes internal bleeding.
  • Nausea, vomiting and loss of appetite – They can interfere with patients getting enough nutrients (such as iron, folic acid, and vitamin B12) needed to make red blood cells.

Signs and Symptoms

Signs and symptoms of anemia include:

  • Dizziness or fainting
  • Shortness of breath
  • Feeling very weak and tired
  • Fast heartbeat
  • Pale skin

Diagnosis of Anemia

A complete blood count test is the most common way of diagnosing anemia. The test measures red blood cell counts in 2 ways – hemoglobin and hematocrit. Hemoglobin is a protein that transports oxygen. Hematocrit is the percentage of the blood made up of red blood cells.

Treatment of Anemia

Treatment may include:

  • Red blood cell transfusion – Patients receive red blood cells by vein either through their central venous access device or a peripheral IV. This treatment is very common in cancer patients.
  • Medications – On rare occasions, care providers may prescribe medicines that stimulate the production of red blood cells.
  • Vitamin and mineral supplements – In very few cases, the care team may recommend supplements that support red blood cell production such as iron, folic acid, or vitamin B12. But vitamin or mineral deficiency usually is not the cause of the anemia.

Ways to Manage Anemia

Patients can take steps to deal with anemia:

  • Balance rest with activity. Try taking short naps during the day balanced with some physical activity. Keep in mind that too much bed rest can make people feel weak. 
  • Sleep the recommended time each day (including naps.):
    • Infants – 12-16 hours
    • 1-2 –11-14 hours
    • 3-5 – 10-13 hours
    • 6-12 – 9-12 hours
    • 13-18 years –8-10 hours
      Source: American Academy of Pediatrics and the American Academy of Sleep Medicine
  • Eat and drink healthy foods and beverages -- Talk with the care team to learn what foods and drinks are best.

Reviewed: August 2018