Cancer Treatment and Low Platelet Count

Having cancer treatment is not always an easy road. Some side effects can be extremely difficult or serious. But there are steps you can take to prevent and manage these side effects.

One possible side effect from cancer treatment is a low platelet count (thrombocytopenia). This means the number of platelets in your blood is lower than normal.

Platelets are blood cells that form clots to stop bleeding. They are made in your bone marrow and travel all over your body. Cancer treatment can lower your platelet count. This is because it damages the bone marrow where platelets are made.

A low platelet count can cause heavy bleeding, even with very small cuts or bruises. This bleeding can become life-threatening if your platelet count is very low. The lower your platelet count is, the higher your risk for heavy bleeding.

What cancer treatments can cause low platelet count?

Certain types of chemotherapy, radiation therapy, and targeted therapy may cause low platelet counts. Cancer treatments used in large amounts or in combination with each other may cause low platelets counts. Low platelet counts related to cancer treatment are often short-term (temporary). Ask your provider if your treatment puts you at risk for low platelet count.

Symptoms of a low platelet count

You may not have any symptoms that your platelet count is low. A blood test could find this problem before you notice any signs.

But if you have any of these symptoms, talk with a healthcare provider right away:

• More bruises than normal

• Small purple or red dots under your skin

• Nosebleeds or bleeding gums

• Black or bloody-looking poop

• Red or pink pee

• Bloody vomit

• An abnormally heavy menstrual period

• Bad headaches

• Muscle or joint pain

• Dizziness

• Blurry vision

• Weakness that gets worse

• Abnormal bleeding that doesn’t stop after a few minutes

Diagnosis

Your healthcare provider may do a physical exam and ask you about your symptoms. They will also use a blood test called a complete blood count (CBC) to monitor your platelet levels.

Treatment

There are a few options for treating a low platelet count during cancer treatment. They include:

• Having a platelet transfusion. If your platelet counts are very low, you may need a transfusion. This is when platelets from a donor are added to your blood through an IV (intravenous) line inserted into your vein. A transfusion of platelets into your blood can help prevent heavy or unexpected bleeding. The platelets from a transfusion only last in your blood for about 3 days. You may need several transfusions depending on your situation.

• Changing your treatment schedule or dose. Your provider may decide to give you a lower dose of medicine. Or to wait longer between treatment cycles.

What you can do

Remember that over time, your platelet count will return to normal. In the meantime, try the tips below to stay safe while you are having this side effect.

How to prevent bleeding

• Be extra careful when using scissors, knives, needles, or other sharp objects. Protect yourself from cuts and scrapes.

• Use an electric razor when shaving.

• Don't do contact sports or any other physical activities that might cause you to fall.

• Take care to prevent burns when you are cooking.

• Use a soft toothbrush.

• If your mouth is bleeding, rinse it with ice water.

• Ask your healthcare team if you can floss your teeth. You may need to wait until your platelet count is back to normal.

• Blow your nose gently.

• Use a nail file with rounded ends to trim nails instead of nail clippers.

• Don’t walk around with bare feet, inside or outside.

• Don't put anything in your rectum. Don’t use enemas or suppositories. Check with your cancer care team before using laxatives.

• Don't take anti-inflammatory pain medicines unless your provider tells you to take them. This includes aspirin, naproxen, and ibuprofen.

• Ask your provider before drinking alcohol or taking any new medicine. These can make bleeding problems worse.

What caregivers can do

• Help prevent injury and falls by removing hazards in the home.

• If bleeding starts, press a clean cloth onto the area until the bleeding stops.

• For nosebleeds, have the person sit up with their head tilted forward. This will keep blood from dripping down the back of the throat. Put ice on the nose and pinch the nostrils shut for 5 minutes.

What to do if you are bleeding

• If bleeding starts, stay calm. Sit or lie down and get help. Press a clean cloth onto the area until the bleeding stops.

• Call your care team or get medical help right away if you have abnormal bleeding. Or if bleeding of any kind does not stop.

Questions to ask your cancer team

It’s important to be honest with your care team so they can help you stay well. If you’re concerned about your platelet count, here are a few questions you may want to ask:

• Am I at risk for a low platelet count?

• How often will I get tested for a low platelet count?

• What symptoms should I look for?

• What should I do to protect myself if I have a low platelet count?

• How long should I follow these precautions?

• When should I call a provider if I start bleeding? What else should I do?

• What is the best way to reach providers' offices after hours, and on weekends and holidays?

Remember, your cancer care team wants to help you stay as healthy as possible during your cancer treatment. Share your concerns with them and anyone helping you during your treatments.