Anemia during chemo

[Rebel Spirit]

I had a TAH/BSO on March 9th. I was diagnosed with Stage IIc ovarian cancer. I have had 5 rounds of carboplaitin/taxol. I have been anemic since the second round of chemo. I have been taking Aranesp shots weekly since then and daily doses of a multivitamin and iron supplements. The iron supplements are 56 mg per day. I am still anemic and the RBC morphology is noted on each blood test. My question is: can chemo permanently damage my bone marrow? Could I be battling my anemia for the rest of my life? Any light you can shed on this problem will be greatly appreciated.

[Annekathryn Goodman, M.D.]

Hi Rebel Spirit,

I have a few questions for you:
Is your blood problem only involving the red cells (hemotocrit (hct) and hemoglobin (hbg))?
What exactly are the values for your hct and hbg?
How are your white blood cell counts and platelet counts?
Are you taking any other medicines aside of meds related to your chemotherapy such as herbs, supplements, antibiotics?
Is there any family history of anemia such as Thalassemia or Sickle cell anemia?

In general, chemotherapy will temporarily cause a reduction in your three major lines of blood cells (reds, whites, and platelets). Different chemotherapies selectively affect the three blood cell types in different ways. Some people only have a problem with their  whites or their platelets and so forth. Chemotherapy especially primary chemotherapy does not affect the bone marrow progenitor cells. So once you have completed chemotherapy, your blood counts will return to normal. People who have required multiple different lines of chemotherapy will have more and more effect on the bone marrow. People who receive high dose chemotherapy or bone marrow transplantation doses of chemotherapy definately will experience a significant loss of bone marrow reserve. People who receive radiation will lose bone marrow function in the area that received radiation.

For you, the doses of chemotherapy you are receiving usually do not cause permanent damage. It is not unusual to be mildly or moderately anemic while you are on chemo. For people who continue to be anemic out of proportion to what is expected, they need a careful evaluation.

Sometimes other medicines can depress bone marrow regeneration. The most common group of drugs are antibiotics. It is also important not to take herbs or other supplements during chemo because some of these substances can reduce the body's ability to metabolize other medicines. In that case, chemotherapy drugs will stay in the system longer and cause more side effects.

Sometimes a person is having ongoing blood loss such as from a gastric ulcer or a polyp in the colon. It is important to have a test for occult blood in the stool.

Finally, some people have a problem with the production of blood cells. The most extreme form of that is called aplastic anemia. For people with unexplained severe anemia, low platelet counts, etc, a bone marrow biopsy is done to evaluate the health of the bone marrow.

[withe]

A related discussion, successful bone marrow transplants was started.