Low blood counts are a common problem for cancer patients. Chemotherapy drugs target growing, dividing cells in the body such as cancer cells. Unfortunately, they also affect normal dividing cells in the body.These include the hair follicle, the lining of the mouth and GI tract, and bone marrow cells. When hair follicles are affected by chemotherapy, patients lose their hair. Similarly when bone marrow cells are affected by chemotherapy, patients can have a lowering of their blood cells counts. The main blood cells in the body are red blood cells, white blood cells, and platelets. All three types of blood cells can be affected by chemotherapy.

Low Red Blood Cells (Anemia)

Anemia occurs when there is a low level of red blood cells in the bloodstream. Red blood cells deliver oxygen from the lungs to the the body. Symptoms of anemia include fatigue, dizziness, and shortness of breath. Anemia is a common problem for cancer patients. If red blood counts are low enough (usually less than 8.0 g/dL), then a blood transfusion is considered. A red blood cell growth factor called erythropoietin (Procrit, Aranesp) can be administered by a subcutaneous shot every 2 to 3 weeks to help stimulate the bone marrow to produce red blood cells.

Low White Blood Cells (Neutropenia/Leukopenia)

Neutropenia (or leukopenia) occurs when there is a low level of white blood cells in the bloodstream. White blood cells, especially a specific type of white blood cells called a neutrophil, fight against infection. Low neutrophil counts place a patients at risk for infection. Neutropenia or leukopenia is a major concern for cancer patients. When patients have low neutrophil counts (less than 1500 uL) the risk of infection increases. Usually white blood cells are at their low point (called the nadir) roughly 7 to 14 days after chemotherapy given every 3 to 4 weeks. During this time, patients need to watch for signs of infection such as fever, chills, cough, urinary complaints, etc. Patients with a low white blood cell count and fever (especially greater than 100.5) should be seek medical attention, even if it is 2:00 am in the morning. Some patients with fever, but otherwise stable, can be managed with outpatient oral antibiotics. Patients with very low white blood cells counts (neutrophils less than 500 uL) should consider seeking medical attention for even the slightest fever or symptoms of infection. These patients have the highest risk of serious infection.

Low Platelets (Thrombocytopenia)

Thrombocytopenia occurs when there are low levels of platelets in the bloodstream. Platelets help the blood clot. Symptoms of thrombocytopenia include easy bruising, nosebleeds, and bleeding gums. Patients are at increased risk of bleeding when the platelet count falls below 20,000 uL. If these symptoms occur, a patient should have their blood counts checked to see if they have low platelets. Patients may require a platelet transfusion. Taking aspirin or NSAID medications (ibuprofen, advil, motrin, naprosyn, etc) can increase the risk of bleeding when your platelets are low. These medicines should be avoided if possible. Tylenol (acetaminophen) does not affect platelet function and is a safer alternative for patients with low platelets.