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How can the Hb of someone suffering from cancer be improved?

Q: My 10 years old son is undergoing chemotherapy. He is on a high risk protocol. His haemoglobin hasn't improved at all. He had a transfusion 3 weeks ago. Now it has gone down to 4.1. I am totally baffled with the various advices people give me. Some say, that cancer patients should avoid red meat and sugar etc. But I have also heard that red meat helps improve blood sugar. Is that true?

A:Anaemia is common in cancer patients, especially those who are receiving chemotherapy. The anaemia is due to several causes including anaemia of chronic disease, resulting due to an inflammatory response of the body to the cancer, in which proteins called cytokines are secreted that reduce the production of some haematopoietic growth factors, especially erythropoietin, and impair the bone marrow response to this hormone; Some chemotherapy agents affect the bone marrow directly and impair red cell production; Cancer involving the marrow can crowd out normal bone marrow cells; Some drugs damage the kidney affecting the production of erythropoietin; use of radiotherapy which damages the marrow and nausea, vomiting, and loss of appetite as a side effect of chemotherapy can cause a deficiency in the nutrients needed to make RBCs, including iron, folic acid and vitamin B12. Symptomatic anaemia is treated by packed cell transfusions and use of erythropoietin. If anaemia is caused by a nutritional deficiency, iron or folic acid tablets or vitamin B12 injections may be given. A diet rich in iron and folic acid will help. Absorption of iron from food is influenced by multiple factors. One important factor is the form of the iron. Dietary iron is available in two valency states, Fe 2+ (ferrous) and Fe 3+ (ferric). The majority of ferrous form is found in haeme iron (as haemoglobin & myoglobin in meat and meat products) while most ferric iron is found in non-haeme iron (plant foods like cereals, vegetables, pulses, dried fruits etc.). Haeme iron, found in animal sources, is highly available for absorption in contrast to non-heme iron found in vegetable sources. Vegetarians need more iron in their diets than non-vegetarians because the iron from plant foods is not as well absorbed as it is from animal foods. Vegetarians should choose several iron-rich plant foods daily. Grains, beans and lentils, vegetables (green-leafy ones, tomato, potato, green & red chillies etc), fruits, nuts and seeds are rich sources of non-haeme iron. The absorption of non-haeme iron can be improved when a source of haeme iron meat/fish/poultry is consumed in the same meal or iron absorption enhancing foods like fruits/fruit juices are consumed. But coffee/tea and calcium if consumed along with a meal impair iron absorption. Give him a diet which he enjoys supplementing his favourite foods with items rich in iron.

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