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Bone Marrow Suppression During Chemotherapy

What Changes Happen with Your Blood and What Does that Mean?


Updated July 14, 2014

Bone marrow suppression (a decreased ability of the bone marrow to manufacture blood cells) is a common side effect of chemotherapy. We often hear about a low white blood cell count (neutropenia) increasing the risk of infection during chemotherapy, but other blood cells made in the bone marrow can be affected as well. What should you know about this common side effect of chemotherapy?

What Causes Bone Marrow Suppression During Chemotherapy?

Chemotherapy affects not only cancer cells, but other rapidly dividing cells in the body as well. This includes the cells in the bone marrow that go on to become red blood cells (RBCs), white blood cells (WBCs), and platelets.


The symptoms of bone marrow suppression depend upon the type of blood cells affected (and how severely they are affected,) and may include fatigue (due to anemia), easy bruising (due to a low platelet count), and infections (occurring secondary to a low white blood cell count).


Before and after chemotherapy, your doctor will order a complete blood count (CBC), to see if any of your blood counts are low. Further evaluation and treatment will depend upon which, if any, of these are low. Bone marrow suppression can result in anemia, neutropenia, or thrombocytopenia.

Chemotherapy Induced Anemia (Low Red Blood Cell Count)

A decreased level of red blood cells is termed anemia. Symptoms of anemia may include:

Depending upon the level of your red blood cells, your doctor may reassure you that your anemia will improve after you are done with chemotherapy, or may recommend treatment with a medication to stimulate red blood cell production, prescribe iron supplements, or recommend a blood transfusion.

Chemotherapy Induced Neutropenia (Low White Blood Cell Count)

A low white blood cell count resulting in neutropenia can be a serious complication, in that it increases the risk of infection. Symptoms of infection may include:
  • A fever greater than 100.5 F.
  • Chills
  • Cough
  • Shortness of breath
  • Redness or drainage around an injury or entrance to the body such as a Port or IV line

During chemotherapy your doctor will advice you to avoid situations that could result in infection, such as spending time with people who are ill or shopping in crowded malls. If your white count is very low, he may recommend that your next chemotherapy treatment be delayed, or prescribe medications to help prevent infection or stimulate production of white blood cells.

Chemotherapy Induced Thrombocytopenia (Low Platelet Count)

Since platelets are responsible for blood clotting, a low platelet count can result in bleeding. Signs of thrombocytopenia can include:
  • Easy bruising
  • Petechiae - red spots on your skin that stay red even when you put pressure on them
  • Joint and muscle pain
  • Blood in your urine or stools
  • Heavy menstrual periods

If your platelet count is too low or you have problems with bleeding, your doctor may recommend a platelet transfusion or a medication to stimulate your bone marrow to make more platelets.

Tips For Coping

Your health care team will monitor your blood counts and recommend treatment if these become too low, but there are several things you can do take care of yourself at this time:
  • Practice careful hand washing
  • Call your doctor with any signs of infection, such as a fever greater than 100.5 F, coughing, chills, shortness of breath, or pain with urination
  • Rest when your are feeling tired
  • Stand up slowly after you have been resting
  • Avoid medications such as aspirin and ibuprofen that can increase bleeding
  • Take special care to avoid situations where you could be cut or otherwise injured


American Cancer Society. Blood Counts. Low platelet count. 04/07/08. http://www.cancer.org/docroot/MBC/content/MBC_2_3x_Blood_Counts.asp.

American Cancer Society. Infections in People with Cancer. 09/08/08. http://www.cancer.org/docroot/ETO/content/ETO_1_2X_Infections_in_People_with_Cancer.asp.

Cella D. Quality of life and clinical decisions in chemotherapy-induced anemia. Oncology (Williston Park). 2006. 20(8 Suppl 6):25-8.

Crea, F. et al. Pharmacologic rationale for early G-GSF prophylaxis in cancer patients and role of pharmacogenetics in treatment optimization. Critical Reviews in Oncology/Hematology. 2008. Dec 24. (Epub ahead of print).

Davidson, B. Communicating about chemotherapy-induced anemia. The Journal of Supportive Oncology. 2007. 5(1):36-40.

Hensley, M. et al. American Society of Clinical Oncology 2008 clinical practice guidelines update: the use of chemotherapy and radiation therapy protectants. Journal of Clinical Oncology. 2009. 27(1):127-45.

Pascoe, J. and N. Steven. Antibiotics for the prevention of febrile neutropenia. Current Opinions in Hematology. 2009. 16(1):48-52

U.S. Department of Health and Human Services. National Institute of Health. National Heart Lung and Blood Institute Disease and Conditions Index. Anemia. August 2008. http://www.nhlbi.nih.gov/health/dci/Diseases/anemia/anemia_whatis.html.

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