Thrombocytopenia (a low platelet count in the blood) occurring as side effect of chemotherapy is less of a problem than in the past, but can still be a serious. What should you know about this concern during chemotherapy?
What Is Thrombocytopenia?Thrombocytopenia is defined as a decreased number of platelets in the blood, which can result in poor blood clotting. Thrombocytopenia is usually defined as less than 150,000 platelets per cubic millimeter of blood (normal platelet range is 150,000-400,000), although significant bleeding does not usually occur until the level drops below 20,000. That said, there is not a clear relationship between platelet level and the tendency to bleed.
What Causes Thrombocytopenia During Cancer Treatment?Chemotherapy destroys rapidly dividing cells, including those in the bone marrow that are needed to make platelets. Bleeding, such as during surgery, and medications can also contribute to thrombocytopenia during cancer treatment.
DiagnosisYour doctor will order a complete blood count (CBC) before and after chemotherapy to see if you have a low platelet level.
SymptomsSymptoms you might experience with thrombocytopenia include:
- Easy bruising
- Bleeding – From your nose, rectum (black or bloody bowel movements), or stomach (vomiting blood or coffee-appearing material)
- Petechiae – Red spots on your skin (most common on the lower legs), that do not turn white when you press them with your fingers
- Ecchymosis – Larger reddish-blue patches (bruises) on your skin
- In women, periods that are heavier than normal
- Joint and muscle pain
Treatment/PreventionDepending upon the level of your platelets, and if you have any symptoms, your doctor may recommend treatment to raise your platelet count. Options include:
- Platelet transfusions - Platelet transfusions can be used as a therapy (to increase platelets in those who are actively bleeding) or preventatively (for those with a low or expected low platelet count but who are not bleeding). The most common side effect is a temporary fever. Rare side effects can include transfusion reactions, or contracting an infection such as hepatitis.
- Medications that stimulate the formation of platelets - Medications are sometimes used to stimulate the bone marrow to make more platelets. The most common side effect is fluid retention (swelling). One of these medications is oprelvekin (Neumega).
- Clinical trials are ongoing, looking at other methods to lower the risk of thrombocytopenia during chemotherapy
CopingIn addition to any treatment recommended by your doctor, if you are at risk for thrombocytopenia try to:
- Avoid aspirin and anti-inflammatory medications such as ibuprofen. Ask your doctor about any over-the-counter or herbal medications you take, since some of these can increase bleeding
- Avoid alcohol
- Use a gentle toothbrush. Many oncologists recommend that you avoid using dental floss as well, but this has not been proven to help
- Use an electric razor
- Blow your nose gently
- Try not to become constipated, and if you do, avoid straining or using suppositories. Some pain medications, as well as dietary changes, can cause constipation, and your doctor may recommend a stool softener or other medications for you during chemotherapy to prevent this.
- Avoid situations where you could be injured or otherwise hurt yourself. Take extra care when using scissors, while cooking, and using tools. Avoid contact sports.
When to Call the DoctorYou should let your doctor know if you develop any symptoms of thrombocytopenia. Call her immediately if you have bleeding that you are unable to stop, a new headache, blurred vision or weakness.
American Cancer Society. Blood Counts. Low platelet count. 08/11/11. http://www.cancer.org/treatment/treatmentsandsideeffects/physicalsideeffects/dealingwithsymptomsathome/caring-for-the-patient-with-cancer-at-home-blood-counts
Blajchman, M. et al. New strategies for the optimal use of platelet transfusions. Hematology. 2008. 2008:198-204.
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.
Kuderer, N. et al. A prediction model for chemotherapy associated thrombocytopenia in cancer patients. Journal of Clinical Oncology. 2006. 24(18S):8616.