It turned out that these patients had iron deficiency coming from blood loss from colon cancer. These iron deficiencies can lead to a craving to chew or eat ice chips. Iron deficiencies can affect the mucosa in the gut and mouth, and ice chips may relief some of the discomfort caused by iron deficiencies.

My patients diagnosed with anemia underwent colonoscopies and were found to have colon cancer, which in both cases resulted in a curative removal by surgery and successful adjuvant chemotherapy.

Usually iron deficiencies develop over a long period of time. When diagnosed it takes months to replace iron in the storage in the body. Iron is critical for red blood cell production. We usually use Slow Fe because it is better tolerated than other preparations which can cause stomach upset.

You need to know if you take iron supplements your stool may look black, similar to patients who have bleeding from their stomach. When there is bleeding in the stomach the stool is black because of its interaction with stomach acid. When bleeding  is in the colon, the stool is red.

If you are abnormally craving ice chips, make sure you are checked for iron deficiency.

The Guides are designed to help patients make informed decisions about the risks and benefits of using ESAs and to give them a starting point for discussions with their doctors.  The Medication Guide must be given to directly patients or their caregivers at the time an ESA is dispensed.

Erythropoiesis-stimulating agents trigger the bone marrow to produce more red blood cells when anemia is due to low red cell counts.   For cancer patients, ESAs are only used during chemotherapy to reduce the need for blood transfusions.  They are not appropriate for anemic cancer patients who not are having chemo, nor are they approved for chemotherapy patients whose treatment goal is cancer cure.

The FDA tells cancer patients who are considering ESA treatment that

• The tumor may grow faster and the patient may die sooner when ESA treatment is used.
• The healthcare provider should prescribe the lowest dose of the ESA that is needed to avoid red blood cell transfusions.
• ESAs work by stimulating the bone marrow to make more red blood cells. ESAs have not been shown to improve the symptoms of anemia, quality of life, fatigue, or well-being for patients with cancer.   For that reason, ESAs should be used only to reduce the chance that a patient with low red blood counts (anemia) will get a blood transfusion.
• Treatment with an ESA should be stopped when chemotherapy treatment is finished.

The Medication Guides warn about the dangers of blood clots while using ESAs and tell patients to call their healthcare provider or get medical help right away if they have any of these symptoms of blood clots:

Chest pain

Trouble breathing or shortness of breath

Pain in the legs, with or without swelling

A cool or pale arm or leg

Sudden confusion, or trouble speaking or understanding speech

Sudden numbness or weakness of the face, an arm, or leg, especially on one side of the body

Sudden trouble seeing

Sudden trouble walking, dizziness, loss of balance or coordination

Loss of consciousness (fainting)

There is also risk of serious heart problems such as heart attack, stroke, heart failure, and a higher chance of death if patients are treated with an ESA to a hemoglobin level above 12 g/dL.