what to expect after your chemotherapy

Low Blood Cell Count

While working to destroy cancer cells, chemotherapy and radiation therapy can also destroy enough good blood cells to cause a short term decrease in your blood counts.  It is important that you understand how each of your blood cells work, and be able to recognize the different signs and symptoms when the blood counts are low.  By recognizing these symptoms, it will help you to decrease or prevent many problems.

What Are Red Blood Cells?
Red Blood Cells (RBC) – Red Blood Cell’s carry oxygen to all parts of the body to give you energy.  If your RBC count is low (anemia), you may look pale and feel tired.

What Is Hemoglobin?
HemoGloBin (HGB) – The hemoglobin in the RBC carries oxygen. If your HGB is very low (8.0 gm or less), your doctor may want you to have a blood transfusion.

What Are Platelets?
PlateLeTs (PLT) – Platelets help stop bleeding by clotting the blood. Platelets are white-yellow in color.  The normal count is 150,000 to 450,000.  During and after chemotherapy, your platelets may be low.  When the platelet count drops to less than 50,000, you may notice more bleeding when you get a cut.  You may bruise easily or have nose bleeds.  If your platelet count is less than 20,000 and there are signs of bleeding, you may need a platelet transfusion.  Platelet counts less than 10,000 may require platelet transfusion because you can bleed without injury.

Important Signs To Know About Low Platelet Count:

If you have any of these signs call your doctor:

  • Bruising easily.
  • Small red-purple dots on the skin (petechiae).
  • Blood in the urine or vomit.
  • Black (looks like tar) or bright red bowel movements.
  • Bleeding from the gums, mouth, nose, vagina or rectum.

If you have a nose bleed call your doctor:

  1. Sit up and lean forward.
  2. Squeeze your nose tightly.
  3. Put ice in a washcloth and place it on your nose.

When Receiving Chemotherapy, You Should Avoid:

  • Aspirin or NSAIDs  (Advil, Motrin Ibuprofen, Aleve).
  • Rough sports (contact sports).
  • Rectal temperatures, enemas or suppositories without permission from the doctor.
  • Unsafe situations that can result in a fall or injury.

What Are White Blood Cells?
White Blood Cells (WBC) – White blood cells fight infection.  The normal count is 4,000-10,000. During and after chemotherapy, your count may be low.  The WBC that fights infection first are the neutrophils (Segs). Young neutrophils are called Bands.

What Are Neutrophils?
A kind of white blood cell, the neutrophils (Segs and Bands) help your body fight infection.

What Is An Absolute Neutrophil Count?
Absolute Neutrophil Count (ANC) – The ANC measures the amount of infection-fighting WBC’s.

How to Measure the Absolute Neutrophil Count (ANC):
(Example: Segs = 45%   Bands = 7%  WBC = 3.4)

  1. WBC multiply by 1,000…(3.4 x 1,000 = 3,400)
  2. Add segs + band… (45 + 7 = 52%)
  3. Multiply WBC x percentage…(3,400 x 0.52 = 1,768)

What Is Neutropenia?
Neutropenia usually occurs when the white blood cell count (WBC) drops below 4.0, and the absolute neutrophil count (ANC) is below 1000. Severe neutropenia is when the ANC is less than 500.

What Happens When You Have Neutropenia?
Because you have a low white blood cell count, you are at a higher risk for infection. The risk of infection increases as the WBC count decreases, because white blood cells – neutrophils, lymphocytes, monocytes, eosinophils, and basophils function to protect the body from infection.

How Do You Know You Have An Infection?
If you have neutropenia (low WBC count), your body will not have enough neutrophils to fight infection, so you may not see the usual signs of infection.  A temperature elevation or fever is the most reliable sign of infection if you are neutropenic.

Immediately Report These Symptoms By Calling Your Doctor:

  • Temperature greater than 99.5°F or 37.5°C. (If you have difficulty reading a thermometer, let your nurse or doctor know).
  • Burning, hesitancy, or difficulty emptying your bladder when urinating. Sore throat or difficulty swallowing.
  • Cough with or without sputum (phlegm).
  • Reddened or painful sores with or without pus.
  • Shaking chills or sweating.
  • Burning or pain in your rectum.
  • Soreness or red or white patches in your mouth.
  • Drainage from an eye or ear.
  • Flu -like symptoms: aching joints, headache, and fatigue.

Although You Can’t Prevent Infection, You Can Minimize Your Risk!

  • Avoid people with colds or contagious illnesses.  Do not share food utensils.
  • Avoid crowds, especially in the winter.  Avoid sitting next to someone who appears to have a cold or symptoms of a contagious illness.
  • Wash your hands with soap before preparing or eating food and after using the bathroom.  Have visitors wash hands, too.
  • Don’t provide direct care for pets.  Don’t change litter boxes or clean bird cages.
  • Unless told otherwise, drink at least 8 cups of liquid daily.
  • Protect your skin from cuts and burns.  Wear shoes or slippers to prevent cuts on your feet.  Wear gloves to garden.
  • Avoid straining to have bowel movements.  Check with your doctor if you need a stool softener.  Don’t use enemas or suppositories without permission.
  • Obtain a digital thermometer and take your temperature orally or under the arm. NEVER take a rectal temperature. Know your baseline temperature.
  • If you need dental work, consult with your doctor before making arrangements.
  • Eat a well-balanced diet.  Wash fruit and vegetables well with warm water.
  • Ask your doctor if vaccines are safe for you and your family.
  • Notify your children’s school to alert you about any chicken pox breakout or exposures in the school.  Notify your doctor immediately if anyone at home is exposed to chicken pox (needs to be notified within 72 hours from exposure).

Always check with your doctor before taking any medications.

If you have any concerns or questions, please call your doctor.