Tuesday, February 16, 2010

Chemotherapy-induced anemia

To keep a faithful record of my cancer experience, there are times when I'll have to go negative.  I try to avoid it, mostly because I find this experience so peculiar that it's more funny than anything else.

But, this exhaustion I feel right now - well, it's hard to make a joke out of it.   I thought I was tired when I had active cancer.  Hah!  I spit on that tired.  Say this with an Australian accent:   That wasn't tired, THIS is tired.

Each week when you go in for chemo, the first thing they do is take your blood for a CBC.  They have a machine right there that can read your blood counts within minutes, and then one of the nursing techs drops the results in your lap.

You learn pretty quickly to read what those numbers mean but for newbies to chemo, here is a website that will help you interpret the results.

What is initially important is your white count.  Your white cells are the infection fighting cells.  Surely you remember that video they showed you in elementary school?  Your white cells are the guys in white hats and happy faces rushing out to reach the site of an infection (which of course, has a black hat with a mean face). The white hats pull out their swords, swarming the black-hatted infection and battling it until it is dead and its eyes turn into X's.  (Do kids still watch that?  The fact that an infection was killed is probably too harsh for them now, and the black/white hat might be too racially charged).

Well, imagine if you had no white hats and one of those mean-faced cells got into your body.  Since they are mean, they would multiply and kill you, right?   That's what happens when your whites are low - no guys with swords.

One line of the report they give you says "GRA" or granulocytes.  This appears to be what they use to decide if you get chemo or not. Expected "grans" for me would range from 2.0 to 7.8.  If it goes under 1.5, they typically won't give you chemo.

Unless they do. Mine last week was 1.2 and I got chemo anyway - my doctor allows it if you are a little under.

Tomorrow, unless my whites have gone up on their own, they probably won't give me chemo and instead will have me take Leukine.

Having a low white count is asymptomatic.  You feel fine, you just can't fight off any infection.  Right now I have no way of knowing if they've gone up or not.  You wouldn't even know your counts were low until one day, you catch a cold and wake up in the hospital, near death.

When your white counts are low, you get a bonus lecture from the chemo nurses:  use sanitizers, stay away from sick people, don't eat fresh fruit and vegetables and stay home if at all possible..

A low red count is different.   People are more familiar with a low red count because they know the word "anemia'.  What is signifcant for chemo patients is the hemaglobin line item on your report,  Hemoglobin is the protein in red blood cells that carry oxygen to your body.

I don't remember a video for that one - probably because there were no swords involved.

Expected range for me would be 12.0 to 18.0.   Last Wednesday, mine was 9.8, which means I am anemic. If it gets down to 9.0, they said I will need a blood transfusion.  So, naturally I'm eager to see my blood counts tomorrow - something I never thought I'd say in my entire life.  I have no idea how fast they can drop - or if they even will drop.

Having anemia does bring symptoms and mine have gotten progressively worse over this week. When your oxygen levels are decreased, you feel tired.  Really, really tired.   I am short of breath, even on resting.   I want to sleep all the time but no matter how much sleep I get I don't feel rested.  My body feels heavy - it's hard to move it around. My brain feels like it's covered in gray cotton.   But, the breathlessness is the worst.  Even typing this is making me breathe hard.

I volunteered to go on a field trip next week to San Francisco.  It's likely the last field trip my son will take and he has been excited about it since he heard about it.  Right now, the thought of getting up at 6:30 in the morning, taking a bus to San Francisco with 300 13 year olds, walking through a museum for five hours, sitting outside in the San Francisco fog to eat a bag lunch, and then another two hour bus ride home is almost more than I can imagine.

But, I'll manage.  Maybe if I can skip chemo this week, I can recover a bit.

I've been awake and sitting in the same place for five hours.  It's time for a nap.


  1. Ann, I never had trouble with anemia. This sounds awful. Take those naps. Lots of them. Can you add the iron in your diet? Take care, and I will check back later.

  2. Hang in there. Believe it, you will get through this.................Betty

  3. Hi - my white cell count dropped too - but fortunately I always managed to have all chemo sessions on time. The side effects for me were that I would become tired really quickly, usually after I had eatern, so it was important for the person sitting next to me to remove the plate so my face would hit the table instead.

    Thanks for your note on my blog - ref the mastectomy. Can you let me know if you are due to have rads? My surgeon is not happy about reconstruction before rads. Ta.

    P x

  4. Sorry - would help if I read your blogs in order! Saw that you not having rads - brill news. would they have done the rads with the tissue expander in?


  5. Hi, Ann; I became anemic too; you should be able to get Aranesp infusions to pump up the red cells as a step before transfusion. Most insurers permit that because transfusion is much more expensive and not as easy. Aranesp and the neulastin (I don't know leukine) kept me on schedule.

    I don't know what protocol you are on, but I was able to find (online) the study that my protocol was based on and it helped me communicate with my doctor and his staff. The protocol assumes you will get a certain number of treatments within a time frame. When they wanted to delay my stuff, I held out the protocol and said, no, fix this instead. I have to have xx treatments in xx weeks. (And I want my hair back as soon as possible).

    Great news on the rads.

  6. Thanks Cathy, for the protocol suggestion. I'll check it out.

    Paula, my plastic surgeon said I could have rads with the expander in, but I would have to wait a year to get the implant! It takes a long time for your skin to heal and become stretchy enough for surgery, I guess. That is the main reason I was thinking of skipping rads, even if recommended. A year to get this surgery stuff over with is too much - and keeping the expanders in for a year is too long too! Three months is too long!


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