“The anemia is exhausting me,” wrote a member of myMPNteam. “Anyone else riding the anemia struggle bus?” “Anemia is really hard on the body,” wrote another. “You get soooo fatigued.”

Anemia occurs when the number of red blood cells in a person’s body is lower than normal. Anemia can be a problem for those living with myeloproliferative neoplasms (MPNs) and significantly impact a person’s quality of life. Anemia has many potential causes, and people living with MPNs — which include myelofibrosis, polycythemia vera, and essential thrombocythemia — may have more than one risk factor for developing anemia.

Diagnosing and treating anemia are important steps to feeling your best when living with MPNs. If anemia becomes severe enough, it can also affect your options for treating MPNs and managing symptoms.

What Is Anemia?

Red blood cells carry a protein called hemoglobin that is needed for transporting oxygen throughout the body. In people with anemia, hemoglobin levels are lower than normal, and the body’s ability to take oxygen where it’s needed is decreased. This can lead to the development of symptoms, as the heart, lungs, and other body systems need to work harder to compensate for the decreased hemoglobin.

Symptoms of Anemia

There are many possible symptoms associated with anemia, and many of them are also common symptoms of MPNs or side effects of cancer treatments.

Fatigue

Fatigue is a common symptom of anemia. People living with MPNs often experience fatigue, and anemia can worsen these feelings of being tired, feeling weak, and having limited motivation to engage in activities.

Anemia causes or worsens fatigue because the organs and tissues of the body are not receiving enough oxygen to perform their normal functions.

Other Symptoms of Anemia

Anemia can also cause heart or lung symptoms such as:

• Chest pain
• Elevated heart rate
• Shortness of breath

More symptoms of anemia include:

• Feeling cold often
• Pale skin
• Brittle nails

Some of these side effects can be the same as symptoms experienced with MPNs or side effects from treatments for MPNs.

How Does Anemia Affect People Living With MPNs?

Anemia is common in those with MPNs, especially myelofibrosis. More than 50 percent of people have anemia when they are first diagnosed with primary myelofibrosis. Members of myMPNteam often discuss how anemia affects them. Here are some descriptions in their own words:

• “The anemia brought on restless legs, both day and night, and insomnia.”
• “I have tachycardia [rapid heartbeat] when I exert myself as my anemia worsens.”
• “It saps energy and power. Dying is one thing, sitting around waiting is quite another.”
• “It seems like my anemia plays a role with memory, maybe because there’s an inadequate supply of oxygen reaching the brain.”

One member of myMPNteam shared that they were diagnosed with myelofibrosis after their doctor had investigated the cause of their anemia: “It wasn’t until after four years of unexplained anemia with high platelets that my doctor finally ordered a bone marrow biopsy and found the [myelofibrosis].”

If your anemia becomes severe enough, it may interfere with your MPN treatment plan — or treatment for other conditions. For instance, hydroxyurea, which is sometimes prescribed for MPNs, is not recommended for use in people with severe anemia because it can worsen the symptom.

“At my last visit, the doctor told me I am now anemic, so no more phlebotomies for a while,” wrote one myMPNteam member. “They took me off my arthritis medication because of my anemia, so my joint pain is flaring up,” shared another.

Diagnosing Anemia

Anemia is diagnosed with a blood test that measures hemoglobin. Hemoglobin is measured in grams per deciliter, or g/dL. Normal levels of hemoglobin are different for men and women:

• Men — 14 to 17.5 g/dL
• Women — 12.3 to 15.3 g/dL

Anemia occurs when hemoglobin falls below normal levels.

What Causes Anemia?

Anemia has many causes, and people with MPNs can have more than one reason for having anemia. Some people, including women, adults over age 65, and those taking blood-thinning medications are more likely to develop anemia, regardless of whether they have MPNs.

MPNs

Myelofibrosis and other MPNs can cause anemia directly. In MPNs, cancerous cells can crowd out healthy cells in the bone marrow and interfere with normal blood cell production.

MPN Treatments

Treatments for blood cancers, such as hydroxyurea, can cause anemia as well. These treatments can suppress bone marrow function, which then leads to anemia.

Nutritional Deficiency

Deficiencies in nutrients such as iron, vitamin B12, or folic acid can also lead to anemia. These nutrients are required for the production of healthy red blood cells.

Kidney Disease

Decreased kidney function that some people experience with an MPN may be another cause of anemia. The kidneys play an important role in maintaining normal hemoglobin levels. They release a hormone called erythropoietin, which tells the bone marrow to make red blood cells. When the kidneys don’t function well, they can’t send this hormone signal to the bone marrow.

How Is Anemia Treated?

In mild cases, anemia may not require any treatment. However, it may need to be managed if it’s causing bothersome or dangerous symptoms. Given that a variety of factors can cause anemia, some people may require many treatment options. Determining the cause and best course of treatment is a critical step toward helping someone with an MPN feel their best.

Blood Transfusion

A person with significantly low hemoglobin levels may require a blood transfusion. During a blood transfusion, red blood cells from a donor are administered through an intravenous infusion.

Every cancer care team has a different threshold for when a blood transfusion is needed. Part of the decision is based on how severe a person’s anemia symptoms are and if a blood transfusion may help.

Medications

Drugs prescribed to fight anemia in people with MPNs may include:

• Erythropoiesis-stimulating agents, synthetic versions of the hormone that stimulates red blood cell production
• Androgens (synthetic male hormones)
• Thalidomide
• Lenalidomide

Some MPN treatments, such as combination therapy with JAK inhibitors, may improve anemia.

Nutritional Supplements

If a nutritional deficiency is a partial cause of a person’s anemia, supplementing those nutrients can often help. Folic acid can be replaced with a daily pill. Iron can be replaced with oral supplements or through an intravenous iron infusion. Vitamin B12 can be supplemented via pills or by injections. Always talk with your doctor before trying a new nutritional supplement.

Eating a diet that contains these nutrients can also be helpful to prevent or treat any nutritional deficiencies. Some of the foods that contain these nutrients include:

• Red meats
• Green leafy vegetables
• Beans
• Enriched breads
• Enriched cereals
• Broccoli

Talk With Others Who Understand

On myMPNteam, the social network for people with myeloproliferative neoplasms, more than 2,000 members come together to ask questions, give advice, and share their stories with others who understand life with an MPN.

Are you living with anemia and an MPN? Share your experience in the comments below, or start a conversation by posting on your Activities page.