Chemotherapy Treatment and Your Blood Counts

Chemotherapy Treatment
and Your Blood Counts
This booklet has been developed to help you better understand the chemotherapy treatment you
are about to receive. Here at Moffitt, we firmly believe that we can avoid unnecessary fear and
anxiety through a better understanding of what is happening to you and why. Your doctor or
nurse will review this information with you and answer any questions you may have.
Chemotherapy Treatment:
There are four major forms of cancer treatment, which are used alone or in combination with
each other to remove or destroy cancer cells. These treatments include:
The following discusses chemotherapy in the treatment of cancer. Through studies, we have
learned that chemotherapy drugs affect certain types of cancer.
We have also learned that chemotherapy drugs have side effects. Not all chemotherapy drugs
have the same side effects, and the severity of those side effects is different with each drug and
The drug information handout given to you will explain the typical or expected side effects of
the drugs you will be taking. An important fact to remember is that chemotherapy affects each
person differently. There is no way to predict how you as an individual will react. It is also
important to remember that when side effects do occur, it does not mean that your cancer is
worse or growing. The severity of side effects does not necessarily relate to the effect
chemotherapy has on your cancer.
Chemotherapy is the treatment of choice for some forms of cancer. Its purpose is to destroy
unhealthy cells. The goal is to rid the body and the bone marrow of the unhealthy cells. In
doing this, however, good cells as well as bad cells are destroyed. Chemotherapy drugs do not
have the ability to seek and destroy only unhealthy cells. Due to this cellular destruction, your
immune system, which helps fight infection, may not work as well as it normally would.
The Immune System:
Normally, our bodies have a built-in system of defense for fighting infection. These infection
fighters are called white blood cells and are made in the bone marrow. They travel through
the blood stream attaching themselves to germs and destroying them.
There are many types of germs, or microorganisms, around us at all time. These can be in the
form of:
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We come into contact with germs through:
objects we touch
the air
our food and water
other people
We cannot escape them, yet not all germs can hurt us. Some germs live in certain parts of our
body and serve a purpose without causing us to be sick or infected. For example, we have a
germ that normally lives in our intestinal tract and which helps us digest food. However, if that
germ invades our urinary tract, frequently through improper hygiene, we can develop infection.
This is when our white blood cells, or infection fighters, go to work to destroy the intruding
organism and restore a sense of balance.
Your Blood Counts:
About 7 to 14 days after receiving your chemotherapy treatment, your blood counts may begin
to fall. Nadir is the word that we use to define the point in time when your blood cell counts
are at their lowest. The timing and the severity of the fall in your blood counts depend on:
the chemotherapy drugs and the dosages used for your treatment
your general state of health
your nutritional state
Not all chemotherapy drugs wipe out your blood counts. However, in some forms of cancer,
like leukemia, we expect a severe fall in the blood cell counts.
When we look at our blood cell counts, we look at three main types of cells, each with a
specific job to do.
white blood cells or WBCs
red blood cells or RBCs
White Blood Cells (WBCs)
The main functions of white blood cells, or leukocytes, are to fight infection; defend the body
by destroying foreign organisms; and to produce, transport, and/or distribute antibodies
throughout the immune system. Simply stated, they are the infection fighters. However, there
are different types of white blood cells. All white blood cells function as a part of the immune
system, but not all white blood cells fight active infection. The true infection fighters are the
neutrophils, also called segs or polys, and they are normally the most abundant type of white blood
cell. After chemotherapy, the number of neutrophils may be lowered through destruction and/or
the inability of the bone marrow to make them. If your neutrophils fall below an acceptable
level, you would be at high risk for infection, or neutropenic. You would then require special
precautions, called neutropenic precautions, to help you avoid developing an infection. These
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precautions are described later in this booklet.
Because a fever is usually the first sign of an infection, you should call your doctor if your
temperature is at or above 100.5oF, or if you have shaking chills. This is not the time to retreat
to your bed armed with a box of tissues and a bowl of chicken soup. Infection in a person with
a low white blood cell count is a very serious and potentially life threatening situation. CALL
Red Blood Cells (RBCs)
The main function of red blood cells, or erythrocytes, is to carry oxygen from the lungs to the
body tissues and to carry carbon dioxide from the body tissues to the lungs. This process is
achieved by means of the hemoglobin in the red blood cells. Hemoglobin is the main
component of red blood cells.
After receiving chemotherapy, your red blood cells and hemoglobin may be decreased through
destruction and/or the inability of the bone marrow to make these cells. You may look pale,
feel overly tired and weak, and may even become short of breath. The word to describe how
you may feel is anemic. These symptoms may occur because the hemoglobin that carries the
oxygen needed for your tissues, organs, and muscles has been depleted. If your hemoglobin
falls too low, blood transfusions may be necessary. Vitamins and iron supplements may not
make you feel better and should only be taken with your doctor’s advice.
Platelets, or thrombocytes, are the smallest of the formed elements in the blood and are vital
for blood clotting. A decrease in the amount of platelets in the blood due to destruction and/or
the inability of the bone marrow to make them can lead to bleeding.
After chemotherapy, you may notice that you have a tendency to bruise more easily, or a minor
cut may take much longer to stop bleeding. You may see tiny, pin-like red dots on your ankles,
lower legs and arms. These red dots are called petechiae. You may also notice that your gums
may bleed after brushing your teeth. Chances are you have thrombocytopenia, or a low
platelet count. A severely low platelet count is a serious and potentially life-threatening
situation because bleeding can also occur in your vital organs. CALL YOUR DOCTOR!
Play it safe:
It is not unusual, especially for leukemia patients, to have a fall in all three blood counts:
WBCs, RBCs, and platelets. When all three cell counts fall below an acceptable level, we call
this pancytopenia.
Ask your doctor or nurse when you can expect your blood counts to be low so you can be
prepared. The following is a list of things you can do to help weather the low blood count
When your white cell count is low, or expected to be low, resist infections by avoiding
crowds and people you know who have a cold or flu. Do not do any gardening or clean
the cat box, birdcage, or fish tank.
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Since fever is usually the first sign of infection, you should take your temperature every
day between 4:00 p.m. and 8:00 p.m. Temperatures have a tendency to go up in the
evening. Also take your temperature at any time you feel feverish or develop shaking
chills. Call your doctor if your temperature is at or above, 100.5° F.
Get enough rest and eat plenty of nutritious food to avoid being overly tired and weak,
which can occur from a low red cell count.
Practice safety measures by wearing protective items when needed (i.e. oven mitts) to
avoid the bleeding or bruising that can occur from a low platelet count. Also, wear
shoes or slippers when out of bed, use an electric razor, and avoid rough exercise,
trauma, and falls. Do not take any aspirin or products containing aspirin unless
prescribed by your doctor. Aspirin can increase the chances of bleeding.
Get in the habit of performing good hygiene and mouth care. Salt water and salt and
baking soda mixtures are excellent forms of mouth rinses and should be used after every
meal and before sleep. Avoid commercial mouthwashes because many contain alcohol,
which can dry your mouth. Use a soft-bristled toothbrush to avoid gum bleeding and,
unless you have practiced it on a daily basis, do not floss. Use ointment on your lips to
prevent chapping and cracking.
Do not use enemas, rectal suppositories, or rectally inserted medications for hemorrhoid
problems. Rectal bleeding and infections may occur.
Drink plenty of fluids, at least 2 quarts a day, unless you have been instructed otherwise.
When should I call my doctor?
You should call your doctor if you experience any of the following signs or symptoms:
shaking chills and fever
unusual pain anywhere
severe diarrhea or constipation
bloody urine or stool (bowel movement)
shortness of breath
severe weakness
severe nausea and/or vomiting
bleeding or bruising
rash or other allergic reactions
a cut or sore that will not heal
flu-like symptoms, cough or sore throat
burning or pain when urinating (passing your water)
Neutropenic precautions:
A low white cell count with fever may require hospitalization and a course of intravenous
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antibiotics. While in the hospital, the staff will place you on neutropenic precautions to
protect you from possible infections. The following measures will be instituted:
Always wash your hands thoroughly before and after going to the bathroom/using the
bedside commode and before and after eating/drinking. All staff members and visitors
will thoroughly wash their hands before entering your room.
No live flowers or plants will be allowed in your room. Stagnant water and dirt carry
germs that can infect you.
You may eat fresh fruits and vegetables as long as they are not bruised, aged or brown.
They must be washed for 30-60 seconds under running water before eating them. This
includes thick-skinned fruits that are peeled before eaten, like bananas and oranges. For
more information please refer to the Moffitt publication Diet Guidelines for Patients
with Decreased Immunity.
Do not eat raw fish or meat. They can carry germs.
The door to your room will be kept closed at all times. Visitors or other patients passing
by your room may have a cold, flu, or infection that may enter your room through the
You will have to stay in your room. If you must leave the room, it will be necessary for
you to wear a mask to avoid possible airborne germs. (Masks should be changed every
30 minutes). Avoid other patients walking on the nursing unit. It is better to go outside
the building if possible.
Your family and friends will be instructed to limit their visits. Children are permitted to
visit at Moffitt Cancer Center, but any child (or adult) who has been immunized (had
vaccinations) within the last 10 days, cannot visit you. Also children frequently carry
infections that may not slow them down but can infect you. Please use caution about
Nursing care:
Besides the measures to protect you from infection, your nurses will also:
Check the inside of your mouth for lesions and infections, and provide you with oral
rinses to be used after each meal and before sleep. If you have mouth ulcers, thrush, or
difficulty swallowing, your doctor will order special medications and special rinses.
Inspect your rectal area for lesions, tears, bleeding, and hemorrhoids. Your doctor may
order external medications, special washes, and sitz baths if necessary. Rectal
temperatures, enemas, rectal medications and manipulations will not be performed due
to the risk of infection and bleeding.
Check your vital signs (blood pressure, pulse, temperature) every 4 hours - more often if
Observe your IV (intravenous) site closely for tenderness, redness and bleeding. Your
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IV will be changed every 3 days to avoid possible infection and inflammation of the
vein. However, if a problem arises, your IV will be changed when necessary. Other
procedures will be followed if you have a Port-a-Cath, Hickman or Groshong catheter in
Administer medications. Antibiotics ordered by your doctor are the first line of defense
against germs. Frequently, two or three different types of antibiotics are ordered to
cover different types of germs and these are usually given IV. It is vital that you receive
your antibiotics at the scheduled times to maintain a certain blood level. Therefore, it is
not unusual for your nurse to administer platelets and blood transfusions in between
scheduled antibiotics.
Draw daily blood work to check the status of your blood counts. When ordered by your
doctor, blood is also drawn to check the blood levels of certain antibiotics. The purpose
of these drug levels is to make sure that you are receiving the necessary dosage of the
antibiotics, not too much and not too little. If you have a Port-a-Cath, Hickman, or
Groshong catheter, the nurses will draw your blood through it. However, blood for
some types of blood tests cannot be drawn through these lines, and it will be necessary
for the lab to take blood from your arm.
Although we do all we can to protect you, it is not uncommon for you to still develop an
infection. We discussed before how we have germs in certain parts of our body. They are there
normally and serve a purpose. The reason that these normal germs do not Arise up in a person
with normal blood counts and cause infections is because the white blood cells keep them at a
controllable level. When chemotherapy depletes the white blood cells, these normal germs can
overgrow and cause us to infect ourselves.
When your temperature rises above an acceptable level, your doctor may order blood to be
drawn for blood cultures. The purpose of these cultures is to find out what germs, if any, are
causing the fever and chills so the best antibiotic for killing that germ is ordered.
The bright side:
By now, the burning question in your mind is probably, “will my blood counts ever return to
normal?” Depending on the type of cancer that you have, the chemotherapy drugs given to you,
and the dosage of those chemotherapy drugs, your blood counts usually begin to rise a week to
10 days after nadir. Remember, nadir is the time when your blood counts are at their lowest.
Those with leukemia may have a longer period of neutropenia, or low blood cell count.
Infections are harder to prevent in leukemia patients and the treatments for infections are more
The important thing to remember is that no two people are alike, and chemotherapy will not
affect everyone in the same way. Therefore, the time it takes for your bone marrow to
recuperate and begin making the normal levels of white cells, red cells and platelets, depends on
you and time.
Newly developed medications to promote bone marrow production of certain blood cells can be
used for some patients. Check with your doctor or nurse to see if these medications are right for
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This booklet has been developed to help you understand what is happening to you as a result of
chemotherapy. It still may not give you all the answers, so please use the following space to jot
down any questions you may have for your doctor or nurse.
The telephone numbers of your doctors and nurses are also listed below:
Outpatient treatment room nurse: _______________________
Program/clinic phone number: ________________________
After hours phone number: ___________________________
Produced by the Patient Education Department 1/ 2012.
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