Synopsis
Identify anaemia and fatigue mechanisms without missing bleeding, sepsis, haemolysis or cardiopulmonary danger, correct reversible deficiencies and use red-cell transfusion, iron, erythropoiesis stimulation, rehabilitation and symptom support according to physiology, treatment intent and patient goals.
- Fatigue in cancer is not synonymous with anaemia; assess bleeding, sepsis, thrombosis, heart and lung disease, endocrine toxicity, sleep, pain, mood, medicines and deconditioning.
- First-line anaemia tests are FBC with indices, reticulocyte count and blood film, compared with baseline and treatment cycle to classify production failure, loss or destruction.
- Iron studies require ferritin, transferrin saturation and inflammation context because cancer-associated hepcidin can produce low usable iron despite a normal or high ferritin.
Key red flags
Tachycardia, hypotension, syncope, melaena, haematemesis, brisk vaginal bleeding or expanding tumour haemorrhage requires urgent source control and major-bleeding assessment.
Fever, chills, dyspnoea, wheeze, pain, rash, hypotension or dark urine during transfusion requires immediate cessation and investigation.
Investigation priorities
Classify anaemia by cell size, marrow response and morphological evidence of blood loss, haemolysis, dysplasia or infiltration.
Management branches
Haemoglobin falls or fatigue and breathlessness worsen during cancer care.
- Assess ABCDE danger, bleeding, infection, thrombosis, cardiopulmonary symptoms, treatment timing, nutrition, endocrine features, sleep, mood and current medicines.
- Obtain FBC, reticulocytes and film, iron studies and selected renal, vitamin, thyroid, haemolysis and bleeding tests, escalating unusual multilineage patterns to haematology.
A non-bleeding adult has symptomatic anaemia or falls below the appropriate restrictive threshold.