Understanding and Managing Chemo-Induced Anaemia

What Is Chemo-Induced Anaemia?

Anaemia happens when your body doesn’t have enough healthy red blood cells to carry oxygen around. During chemotherapy, this can be caused by the drugs damaging your bone marrow, the part of your body responsible for producing blood cells.

When chemo-induced anaemia hits, it’s not just about feeling tired. It’s a deep, dragging exhaustion that doesn’t go away with rest. And it’s common, many people undergoing bowel cancer treatment will deal with it at some stage.

Why It Happens During Chemotherapy

Chemotherapy targets fast-growing cells. Unfortunately, that includes healthy cells in your bone marrow, not just cancer cells. This slows down red blood cell production, leading to anaemia.

You might also develop anaemia if:

• You’ve lost blood from surgery or internal bleeding
• You’re low in iron, vitamin B12 or folate
• Your kidneys aren’t producing enough erythropoietin (a hormone that helps make red blood cells)

Signs and Symptoms to Watch For

Some signs of chemo-induced anaemia can overlap with general chemo fatigue, but it’s important to pay attention to how you’re feeling. Let your team know if you experience:

• Unusual or worsening fatigue
• Shortness of breath (even with light activity)
• Dizziness or feeling faint
• Heart palpitations or racing pulse
• Pale skin
• Headaches
• Feeling colder than usual
• Brain fog or trouble concentrating

If you notice any of these, especially in combination, it’s worth getting your haemoglobin levels checked.

How It’s Diagnosed

A simple blood test, usually part of your regular full blood count (FBC) can show if you’re anaemic. It’ll look at your haemoglobin levels, red blood cell count, and other markers.

If your numbers drop too low, your medical team may pause chemo, adjust your dosage, or start treatment to help manage the anaemia.

Managing Chemo-Induced Anaemia

The right treatment depends on how severe your anaemia is and what’s causing it. Here are the most common options:

Iron Infusions or Supplements

If you’re low in iron, your doctor might recommend an iron infusion or oral supplements. Infusions deliver iron straight into your bloodstream, which can be faster and easier to absorb.

Blood Transfusions

If your haemoglobin is very low and you’re feeling severely unwell, a blood transfusion may be offered. This can quickly boost red blood cell levels and ease symptoms like dizziness, breathlessness and fatigue.

Medications

Drugs called erythropoiesis-stimulating agents (ESAs) can encourage your body to make more red blood cells. These aren’t used as often during cancer treatment due to risks, but may be considered in specific cases.

Dietary Support

Eating iron-rich foods won’t reverse chemo-induced anaemia on its own, but it can help maintain your stores:

• Red meat, chicken, fish
• Leafy greens like spinach and kale
• Iron-fortified cereals or grains
• Legumes and tofu
• Vitamin C-rich foods (like oranges or capsicum) can help your body absorb more iron

Ask your medical team or a dietitian before taking any supplements, especially during treatment.

Living With Anaemia During Chemo

Anaemia isn’t just a number on a blood test, it can affect your whole quality of life. These tips can help you cope:

• Listen to your body – rest when you need to, without guilt
• Prioritise tasks – focus on what truly matters each day
• Ask for help – don’t try to push through or mask your symptoms
• Move gently – light walking or stretching can improve circulation, but don’t overdo it
• Sit down in the shower – or use mobility aids if you feel dizzy or weak
• Use the “cancer card” – tell your team if your energy levels are affecting daily life

When to Call Your Doctor

Always let your oncologist or nurse know if:

• You feel short of breath doing everyday things
• You’re faint, dizzy or struggling to stay upright
• Your fatigue feels suddenly worse or different
• You notice blood in your stool or urine (possible bleeding source)

Don’t brush it off as “just chemo.” Anaemia is common, and treatable, but it can become dangerous if ignored.

Support in Australia

You’re not alone in dealing with chemo-induced anaemia. These services may help:

• Your oncology nurse or GP – first port of call for discussing symptoms and getting blood tests
• Hospital dietitian – often available during treatment to help optimise your nutrition
• Bowel Cancer Australia’s Nutrition and Wellness advice line: Call 1800 727 336 for support from an accredited dietitian
• Cancer Council Australia – Offers general info and resources: cancer.org.au

Final Thought

Chemo-induced anaemia is one of those hidden side effects that can quietly wreck your energy and turn everyday tasks into major efforts. But it’s not something you just have to “put up with.” If you’re feeling different, more wiped out than usual, or just off, speak up. Blood tests can give answers, and there are ways to treat it. Managing anaemia can make a real difference in how you feel and function during chemo.

You don’t have to power through this alone.