• red blood cells, which carry oxygen to cells throughout the body 
• white blood cells, which fight infection 
• platelets, which help blood to clot and stop bleeding

Chemotherapy destroys some of the bone marrow cells so fewer blood cells are produced. A drop in the levels of any of these cells leads to specific side effects.

Your doctor will check your blood cell count (by doing a test called a complete blood count or CBC) often during your treatment and may give you growth factors to help your bone marrow make new blood cells.

Anemia

When you have too few red blood cells, your body tissues don't get enough oxygen to do their work. This condition is called anemia. You may have these symptoms:

• fatigue 
• dizziness 
• paleness 
• a tendency to feel cold 
• shortness of breath 
• weakness 
• a racing heart rate

Try the suggestions listed in the previous section if your anemia is causing fatigue. Report any symptoms to your doctor or nurse. Your doctor will check your blood cell count (also called blood count or complete blood count) often during your treatment. If your red blood cell count falls too low, you may need a blood transfusion or treatment with a growth factor to boost your bone marrow’s red blood cell production.

For more information on anemia, please call the American Cancer Society at 1-800-ACS-2345 or visit our Web site at www.cancer.org to get the American Cancer Society/NCCN Cancer-Related Fatigue and Anemia Treatment Guidelines for Patients.

Infection

Having a low white blood cell count, a condition called leukopenia, decreases your body's ability to fight infections. One type of white blood cell, the neutrophil, is especially important in fighting infections. A shortage of neutrophils is called neutropenia.

Infections can begin in almost any part of your body and most often start in your mouth, skin, lungs, urinary tract, and rectum.

If your white blood cell count drops too much, your doctor may postpone treatment, give you a lower dose of chemotherapy, or prescribe treatment with a growth factor that boosts white blood cell production in the bone marrow.

Techniques to prevent infections:

• Wash your hands often during the day, especially before you eat and after you use the bathroom.

• Avoid crowds.

• Stay away from people who have diseases you can catch, such as colds, flu, measles, or chickenpox.

• Do not get any immunization shots without first checking first with your oncologist (cancer doctor).

• Stay away from people who have recently had an immunization, such as a vaccine for chicken pox, small pox, or the flu. (Check with your doctor about which vaccines are important and how long you should stay away from people who have had them.)

• Clean your rectal area gently but thoroughly after each bowel movement. Ask your doctor or nurse for advice if the area becomes irritated or if you have hemorrhoids. Also, check with your doctor before using enemas or suppositories.

• Don’t cut, bite, or tear the cuticles of your nails.

• Be careful not to cut or nick yourself when using scissors, needles, or knives.

• Use an electric shaver instead of a razor to prevent breaks or cuts in your skin.

• Use an extra soft toothbrush that won’t hurt your gums and talk to your doctor before using dental floss.

• Don’t squeeze or scratch pimples.

• Take a warm (not hot) bath, shower, or sponge bath every day. Pat your skin dry using a light touch. Don’t rub.

• Use lotion or oil to soften and heal your skin if it becomes dry and cracked.

• Clean cuts and scrapes right away with warm water, soap, and an antiseptic.

• Wear waterproof gloves when gardening or cleaning up after animals and others, especially small children.

Even if you are being extra careful, your body may not be able to fight infections when your white blood cell count is low. Look out for and check your body regularly for signs and symptoms that you might have an infection. Pay special attention to your eyes, nose, mouth, and genital and rectal areas. The symptoms of infection include:

• fever of 100.5°F or greater when temperature is taken by mouth 
• chills 
• sweating 
• loose stools (This can also be a side effect of chemotherapy.) 
• a burning feeling when you urinate 
• a severe cough or sore throat 
• unusual vaginal discharge or itching 
• redness, swelling, or tenderness, especially around a wound, sore, pimple, IV site, or vascular access device 
• abdominal (belly) pain

Report any signs of infection to your doctor right away. If you have a fever, don't use aspirin, acetaminophen, or any other medicine to bring your temperature down without first checking with your doctor.

For more information on fever and neutropenia, please call the American Cancer Society at 1-800-ACS-2345 or visit our Web site at www.cancer.org to get the American Cancer Society/ NCCN Prevention and Treatment of Cancer-Related Infections Treatment Guidelines for Patients With Cancer.

Bleeding or clotting problems

Chemotherapy drugs can affect the bone marrow's ability to make platelets. These are the blood cells that help stop bleeding by plugging up damaged blood vessels and by helping your blood to clot. If your blood does not have enough platelets, you may bleed or bruise more easily than usual, even from a minor injury. A shortage of platelets is called thrombocytopenia.

Report these signs of thrombocytopenia to your doctor:

• unexpected bruising 
• small red spots under the skin 
• reddish or pinkish urine 
• black or bloody bowel movements 
• any bleeding from your gums or nose 
• bad headaches 
• dizziness 
• an increase in weakness 
• pain in joints and muscles

Your doctor will check your platelet count often during your treatment. If it falls too low, you may need a platelet transfusion.

Techniques to avoid problems if your platelet count is low:

• Don't take any medicine without first checking with your doctor or nurse. This includes aspirin and aspirin-free pain relievers, including acetaminophen, ibuprofen, and any other medicines you can buy without a prescription. Some of these medicines can weaken the platelets and make bleeding problems worse.

• Don't drink any alcohol (beer, wine, or liquor) unless your doctor says it's all right.

• Use an extra soft toothbrush to clean your teeth and talk to your doctor before using dental floss.

• If you have a runny nose, blow gently into a soft tissue.

• Take care not to cut or nick yourself when using scissors, needles, knives, or tools.

• Be careful not to burn yourself when ironing or cooking. Use a padded glove when you reach into the oven.

• Avoid contact sports and other activities that might cause an injury.

• Avoid becoming constipated.

• Use an electric shaver instead of a razor.

• When bending over, keep your head above your heart.

Revised: 03/08/2008