Thrombocytopenia

Thrombocytopenia refers to a low level of platelets. Because chemotherapy kills both cancerous cells and other normal cells that grow at a fast rate, platelets are often destroyed.

Because platelets play an important role in clotting blood, any time your platelets count drops you are at a higher risk of bleeding. Therefore, you must do everything that you can to decrease the risk of injury that could result in bleeding while your are receiving chemotherapy. Even the most minor of injuries, such as small cuts or bumps, can result in excessive bleeding when your platelets are low and therefore must be avoided.

Normal platelet counts are usually in the range of 140,000 – 440,000 per mm³ of blood. After receiving chemotherapy your platelet count will be checked.

Any time your platelet count drops below 50,000 per mm³ you are considered at increased risk for bleeding. A nurse will review with you special steps that you must take in order to decrease your chance for injury that could result in a bleeding episode. These are called platelet precautions and are discussed in greater detail below. If your platelet count drops below 10,000 per mm³ you will require immediate medical attention by your oncologist.

What can I do to prevent bleeding?

It is important to realize that there is nothing you can do to prevent thrombocytopenia/low platelet count that is caused by chemotherapy. However, there are several things that you can do to decrease your risk for injury and bleeding when your platelet count is low and you are at high risk.

• Know what to look for. The signs and symptoms of a low platelet count include the following:
  • Excessive bruising of your skin
  • Tiny, pinpoint red spots on your skin (called petechiae)
  • Bleeding gums
  • Nosebleeds that will not stop
  • Excessive bleeding from a small cut, or bleeding that won’t stop even after pressure has been applied
  • Dark-colored urine or blood in your urine
  • Blood from your rectum, blood in your stool, or black-colored stool
  • Menstrual bleeding that is heavier than usual, last longer than usual or occurs between periods
• Take special precautions with personal hygiene to minimize the risk of bleeding.
  • Keep you mouth clean and moist

a.  Brush your teeth gently with a soft-bristle toothbrush.

b.  If you cannot use a toothbrush, use a sponge toothette to clean your teeth and gums.

c.  Do not use dental floss.

d.  Avoid any commercial mouthwashes that contain alcohol.  Alcohol can dry out your mouth and may lead to bleeding.

e.  Use petroleum jelly or other lip balms to keep your lips moist and to prevent cracking.

f.  Take sips of water or juice frequently if your tongue or mouth feels dry.

g.  Rinse your mouth after each meal with a baking soda solution (2 tsp. baking soda to 8 oz. water).

• Also . . .
  • Do not blow your nose too hard.
  • Do not cough forcefully or harshly. If you have a persistent cough, notify your doctor or nurse, who may recommend a cough syrup.
  • Avoid straining too much with bowel movements. If you have a problem with constipation, ask your doctor for a stool softener or laxative.
  • Do not use rectal thermometers, suppositories or enemas.
  • Women, use sanitary napkins instead of tampons
  • Use only an electric razor for shaving.
• Avoid medications that affect blood clotting.
  • Do not take aspirin or anything that contains aspirin. Check the labels of all drugs you are taking for salicylic acid. If you are not sure about a drug or cannot tell by reading the label, check with your physician, nurse or pharmacist.
  • Do not take any nonsteroidal anti-inflammatory medications such as Motrin, Aleve, Advil, etc.
  • For headaches or other pain, use acetaminophen (Tylenol)
  • Avoid intramuscular shots.
• Adjust your lifestyle to minimize the risk of bleeding.
  • Avoid strenuous activity, lifting heavy objects and bending over from the waist.
  • Adjust your diet.

a.  Drink 8 – 10 8 ounce glasses of fluid a day to keep your mouth moist, the intestinal lining in good condition and to avoid constipation.

b.  Avoid raw and coarse vegetables that are hard to digest and may cause damage to the intestinal lining.

c.  Eat protein- rich foods and beverages such as chicken, turkey, cheese, cooked eggs and milk.

• • Wear shoes or slippers at all times to protect your feet.
  • Do not wear tight-fitting clothing.
  • Use a water based lubricant and avoid vigorous thrusting during sexual intercourse.
  • Avoid drinking alcoholic beverages, including beer and wine.
  • Avoid activities that could result in falling and/or injury including, but not necessarily limited to, bicycling, rollerblading, skating and skiing.

What if I start to bleed?

Even after you have taken special precautions to decrease the chance of injury and bleeding, it is still possible that bleeding will occur. If bleeding occurs, apply firm pressure for 5 minutes to the area. If bleeding does not stop after 5 minutes, continue to apply pressure until it has stopped completely Then call your doctor.

If you have a nosebleed, apply pressure with your fingers below the bridge of your nose until the bleeding stops. Keep your head raised.

When should I call my doctor?

Call your doctor immediately if you have any one or more of the following conditions.

• Bruising or petechiae (small red spots, often on the stomach or legs).
• Bleeding that does not stop after you have applied pressure for 10 – 15 minutes.
• A persistent headache, blurred vision or a change in your level of consciousness.
• Blood in your urine or your urine appears dark in color.
• Blood from your rectum, blood in your stool or your stool is black.
• A change in your vision, decreased attention span, excessive sleeping, confusion and/or difficulty being awakened.
• Bleeding from gums or nose.

If you have a major injury or start spontaneously bleeding, go immediately to the nearest hospital emergency room. Make sure you inform the doctor that you are receiving chemotherapy and that your platelet count may be low, indicating thrombocytopenia.