Anemia’s Link to Fatigue

Robin Wachsman, RN, BSN, OCN, CCRN

As a clinician in a community oncology clinic, anemia is a familiar diagnosis. The most common complaint prior to the diagnosis of anemia is fatigue. Unfortunately, anemia and fatigue often go hand in glove.

Often the onset of anemia is slow and the body is able to compensate. Patients are able to manipulate activities of daily living to accommodate the fatigue. However, anemia can also have a rapid onset causing disruption of day-to-day living.  Often fatigue will become very concerning to the patient and we commonly hear questions and comments such as: How can I continue to work? How can we make the fatigue better fast? I have children at home that need care.

It is not a surprise that fatigue related to anemia was rated as the number one complaint of oncology patients - superseding nausea and vomiting - as having the greatest impact on their energy, activity and lifestyle.      

When we suspect anemia, clinicians work like detectives to seek clues and build a case and cause for the diagnosis. The first step would be to order laboratory values checking for areas of deficiencies, especially iron. Iron values are important because we know anemia can be caused by increased iron demand, decreased iron intake, or blood loss.

Most lab tests will include the complete blood count (CBC) where the results focus on the hemoglobin and hematocrit, serum ferritin-assessing the iron stores, and the transferrin saturation (TSAT). This lab test is drawn to evaluate the adequacy of iron levels for erythropoiesis, a process involving the normal production of red blood cells. 

While lab work is pending, we continue to drill down, attempting to determine the root cause of the anemia. A few questions we would ask include:

  • Has there been any recent blood loss due to surgery or any history of ulcers, polyps or cancer that could cause a slow loss of blood?
  • Could there be a lack of iron in the diet? The body regularly gets iron from the foods we eat. If a person consumes too little iron over time, the body could become iron deficient.
  • Are there any issues affecting the body’s ability to absorb iron? Iron from food is absorbed into the blood stream in the small intestine. Disorders such as celiac disease, surgical procedures such as gastric bypass, or some medications can block the absorption of iron. 
  • Is the patient on any form of growth factor? These factors are most commonly administered in oncology and some stimulate production of the red blood cells, which can quickly deplete iron stores, known as functional anemia.  

Symptoms of anemia and fatigue can be mitigated with appropriate treatment and patient/family education. We encourage patients to set short term goals for the activities of daily living to conserve energy. Plans are developed to help the patients and caregivers develop mechanisms for managing persistent symptoms of anemia (i.e. fatigue, shortness of breath, decreased stamina). 

We also encourage patients to maintain an optimal level of physical activity, allowing rest periods as necessary. A nutritionist can intervene suggesting a well-balanced diet of iron rich foods that will help improve quality of the diet.   

Living with anemia and fatigue can be manageable and there are many different plans of care that have helped patients to live a long, meaningful life. Treatment options will vary for each person and a plan of care will be initiated by your physician or other health care professional.          

The information in this article is for informational purposes only and not intended to provide medical advice. You should direct all questions about your health to your health care provider.

Robin Wachsman, RN, BSN, OCN, CCRN is vice president of clinical education and training at the West Clinic in Memphis, Tennessee and has written extensively on the topic of iron deficiency anemia, with a special focus on IDA in oncology patients.


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