Care During Chemotherapy and Beyond
What is iron deficiency anemia?
Iron is a mineral that is important not only to all the cells in our body, but it
is especially important to red blood cells. Red blood cells make hemoglobin, which
carries oxygen to the tissues in our bodies.
Normal Iron levels are 40-150 ug/dL (female) and 50-160 ug/dL (male). Normal
values may vary from laboratory to laboratory.
Iron deficiency anemia occurs when there is a lack of iron in your body, causing
primarily a low hemoglobin concentration.
What causes iron deficiency anemia?
The most common cause of iron deficiency is bleeding or blood loss, usually from
the gastrointestinal tract. Other causes include a lack of iron in your diet, or
changes in your body due to pregnancy.
Common causes of bleeding in the gastrointestinal tract include:
- Cancer- of the gastrointestinal tract (such as colon or rectum cancer)
- Hemorrhoids - these are swollen veins in the lower rectum. They may be inside your
rectum or anus; or outside your rectum or anus. Hemorrhoids that are inflamed may
be painful when you move your bowels, or "bear down."
- fissures- an anal fissure is a tiny tear of tissue in the anus. Anything that causes
trauma to the lining, such as diarrhea or large, hard bowel movements, may cause
an anal fissure.
- If you have low blood counts from chemotherapy, or your disease, developing an anal
fissure may be a source of infection. Notify your healthcare provider if you have
painful bowel movements, or blood in your stool immediately.
- Inflammatory bowel disease -Diarrhea, abdominal pain and mucous in your bowel movements
are caused by inflammation (swelling and redness) of the lining of the colon. This
may cause rectal bleeding.
- Infection - An intestinal infection can produce diarrhea for 1 - 3 days. You may
notice this after traveling abroad (especially to foreign countries), where you
may not be immune to certain kinds of viruses and parasites.
- You may develop intestinal infections from undercooked food, or other viruses and
- People with a weakened immune system may develop an intestinal infection from the
inability to fight infections.
- Diverticuli - these are finger-like pouches in the wall of the colon. Diverticuli
may become inflamed, when shelled food (such as corn and nuts) become trapped in
the pouches, causing an infection. This is called diverticulitis. Fever, pain in
the left lower abdomen, and blood in your stool all may be signs of diverticulitis.
- Gastrointestinal bleeding - bleeding in the upper part of the digestive system may
be serious. The blood may be heavy and constant. It may be bright red, or maroon
in color. Seek emergency assistance immediately.
- People who bruise or bleed easily, and develop anemia, may have problems with how
their blood clots. If you notice that you are bruising or bleeding easily, notify
your healthcare provider.
What are some symptoms of iron deficiency anemia to look for?
- You may be overly tired, or very weak (fatigued), if you have anemia due to your
bleeding (iron deficiency anemia), or due to another underlying disorder. It may
be hard for you to do any kind of your normal activities.
- If you are severely anemic, you may have shortness of breath, chest discomfort,
palpations, or feel faint like you are going to pass out.
- If you are anemic due to bleeding or blood loss, you may notice the bleeding coming
from your vagina, urine, or from your rectum. However, you may also not notice any
- You may notice bright red blood when you move your bowels. This may mean that you
are losing blood from your lower gastrointestinal tract, which may cause you to
have an iron deficiency
- You may notice the presence of black, tarry or maroon stools when you have a bowel
movement. This may mean that your blood loss is coming from higher up in the intestinal
tract, causing iron deficiency.
- You may have stomach pain or abdominal cramping with your bowel movements.
- You may have pain in your rectum or anal region when you are passing a bowel movement
(defecating), if you have hemmorhoids that may be bleeding.
- You may have fever or chills with your abdominal pain or blood in your stools. This
may be a sign of infection, and you should notify your healthcare provider.
- You may bleed easily and often when you go to the bathroom with a bowel movement.
His may be a sign of a blood clotting disorder, or low blood platelets.
- You may have tiny red dots on your skin, called petechiae (pe-TEEK- ee-ay). These
are commonly found on your lower legs. This is a sign of low blood platelets.
- You may have frequent nosebleeds if you have low blood platelets, or a blood clotting
- You may have no symptoms at all.
Things you can do about iron deficiency anemia:
- To correct the iron deficiency anemia, a source of the anemia must be determined.
If it is due to bleeding in the gastrointestinal tract, or elsewhere, the bleeding
must be stopped before the supply of iron in your body is replenished. Otherwise,
you will again become deficient in iron, if you continue to bleed.
- Increase your intake of iron. If your deficiency is due to a poor dietary intake
of iron, the increased intake of iron can be done through diet and pills. Meat,
poultry and fish have lots of iron. Fruits, vegetables, nuts, (including peanut
butter) legumes (including lima, chili, pinto and kidney beans), enriched cereals
and grains have high amounts of iron as well. The iron found in spinach and egg
yolks are not as easy for your body to absorb.
- Your healthcare provider may suggest iron supplements to correct the iron deficiency.
If you are ordered to take iron pills, make sure that you take them on an empty
stomach, and not with food for 1/2 hour at least. The iron is better absorbed on
an empty stomach. However, if you cannot tolerate the iron, and your stomach becomes
upset, you may take the iron with food. It is better to take the iron with food,
than not to take it at all.
- If your body is unable to absorb iron in your stomach, due to celiac sprue, stomach
surgery, or other stomach problems, your healthcare provider may order intravenous
(IV) iron infusions.
- If your iron deficiency anemia is due to rectal bleeding, caused by hemorrhoids,
or some other bowel abnormalities, it is important to increase the amount of bulk
fiber in your diet per day.
- You can do that by taking 1 tsp. of Metamucil®
in 8 oz. of liquid, once a day. Or,
- You may take Senokot® (senna tabs); 1-2 pills once
or twice a day, depending on your bowel pattern.
- This will promote bowel movements, and prevent constipation and trauma (damage)
to the delicate tissues of your colon and rectum.
- If your anemia is due to bleeding, and you have pain in your rectum, you may take
acetaminophen (Tylenol®) up to 4000 mg per day
(two extra-strength tablets every 6 hours). If you have a bleeding disorder, you
should avoid non-steroidal anti-inflammatory (NSAID) drugs, as well as aspirin,
because these drugs may interfere with blood platelets, or prolong your bleeding.
- People with colon or rectal cancer may have weight loss, fatigue (excessive weakness),
loss of appetite, and a family history of cancer.
- Everyone over the age of 50 should be screened with a sigmoidoscopy. If this is
negative, you should be re-examined every 5 years, or sooner, if suggested by your
- Everyone over the age of 50 years should receive yearly Fecal Occult Blood Testing
(FOBT), which tests your stool for hidden blood.
- You must obtain 3 specimens, on 3 different days. Avoid iron and multivitamin supplements,
or foods high in iron (red meats), or red wine, for 1 to 3 days (depending on your
healthcare provider's suggestions) before the testing. These foods may affect your
results, giving them a false positive result for blood.
- If you notice that you are bruising or bleeding easily, notify your healthcare provider.
- Make sure you tell your doctor, as well as all healthcare providers, about any other
medications you are taking (including over-the-counter, vitamins, or herbal remedies).
- Do not take aspirin or products containing aspirin unless your healthcare provider
- Remind your doctor or healthcare provider if you have a history of diabetes, liver,
kidney, or heart disease.
- You should restrict the amount of alcohol you take in, or avoid it all together.
Alcohol may adversely interact with many medications.
- If you are ordered a medication to treat your anemia, do not stop taking your medication
unless your healthcare provider tells you to. Take the medication exactly as directed.
Do not share your pills with anyone. If you miss a dose of your medication, discuss
with your healthcare provider what you should do.
- If you experience symptoms or side effects, especially if severe, be sure to discuss
them with your health care team. They can prescribe medications and/or offer
other suggestions that are effective in managing such problems.
- Keep all your appointments for your treatments.
Drugs that may be prescribed by your doctor for iron deficiency anemia:
- Treatment of iron deficiency anemia includes identifying and treating the underlying
- For people with normal immune systems, treatment for bleeding due to hemorrhoids,
diverticuli, and anal fissures includes adding a bulk laxative (such as Metamucil
or senna tablets) to your diet daily. Also, you may increase your intake of whole
grains, fresh fruits and vegetables, as tolerated. This will prevent constipation,
and promote stool evacuation. You will also need to supplement your diet with foods
that are high in iron, or take iron supplements
- Ferrous sulfate - this is one of many forms of iron supplements available. These
tablets are taken up to three times a day, on an empty stomach. Your healthcare
provider will prescribe this if your blood iron levels are low, and he or she thinks
they will return to normal with this therapy.
- Iron intravenous (IV) - you will be ordered an intravenous iron infusion, if you
have iron deficiency anemia, and you are unable to absorb iron in your body, due
to stomach problems, or another condition.
- If you have a bleeding disorder, you should avoid non-steroidal anti-inflammatory
(NSAID) drugs, as well as aspirin, because these drugs may interfere with blood
platelets, prolong bleeding, and irritate your stomach.
When to call your doctor or health care provider about iron
- Bleeding that does not stop after a few minutes, or new, unexplained bruises.
- Any new rashes on your skin, especially if you have been taking a new medication.
- Weakness and/or fatigue that interferes with your ability to function.
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Note: We strongly encourage you to talk with your health care professional
about your specific medical condition and treatments. The information contained
in this website is meant to be helpful and educational, but is not a substitute
for medical advice.
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