Blood counts measure 3 important parts of blood:

The hemoglobin percentage measures the ability of the red blood cells to carry oxygen. A normal hemoglobin range is about 14.5 to 18 for men and 12 to 16 for women. Most people still feel well with a hemoglobin percentage as low as 10. A low hemoglobin level is called anemia.

The white blood cell count measures your body’s ability to fight infection. A normal white blood cell count is about 5,000 to 10,000. A low white blood cell count may put you at higher risk of infection. You will want to watch for signs of infection so that you can go to your doctor for treatment right away. A high white blood cell count may be a sign of an infection, or it may be due to certain types of disease.

The platelet count looks at the cells that help your blood to clot. A normal platelet count is about 150,000 to 450,000. Normal clotting is still possible with a platelet count of 100,000. Dangerous bleeding may occur when the platelet count goes below 20,000.

After cancer treatment, it may take a few weeks for your counts to get back to normal. If you see any other doctors or dentists during this time, be sure they know your counts are low. Some very common treatments may cause problems for you. Call the American Cancer Society at 1-800-227-2345 and ask for a copy of Understanding Your Lab Results if you would like to know more about what your lab values mean.

Low hemoglobin

What to look for

• New or worsening tiredness that makes it harder to do your regular activities
• Chest pain or shortness of breath
• Pale skin, nail beds, or gums
• Dizziness
• Weakness
• Blood in stool (bright red, dark red, or black stools)
• Vomiting dark brown or bright red material

(The last 2 are signs of bleeding, which can cause anemia.)

What the patient can do

• Balance rest and activities.
• Tell the doctor if you’re not able to get around as well as usual.
• Plan your important activities when you have the most energy.
• Eat a balanced diet that includes protein (meat, eggs, cheese, and legumes such as peas and beans) and drink 8-10 glasses of water a day, unless your care team gives you other instructions.

What caregivers can do

• Help schedule friends and family members to prepare meals, clean house, do yard work, or run errands for the patient.
• Watch for confusion, faintness, or dizziness, as noted below.

Call the doctor if the patient:

• Has chest pains
• Has shortness of breath when resting
• Feels dizzy or faint
• Becomes confused or cannot concentrate
• Has not been able to get out of bed for more than 24 hours
• Has blood in his stool
• Vomits dark brown or bright red material

Low white blood cell count

What to look for

• Temperature of more than 100.5° F when taken by mouth
• Any new area of redness or swelling
• Pus or yellowish discharge from an injury or other location
• New cough or shortness of breath
• New abdominal pain
• Shaking chills that may be followed by sweating
• Burning or pain when urinating
• Sore throat
• Sores or white patches in the mouth

What the patient can do

• Check your temperature by mouth or under your armpit if you can’t keep a thermometer in your mouth.
• Take acetaminophen (Tylenol^®) for a fever after calling your doctor.
• Keep warm.
• Take antibiotics or other medicine as prescribed.
• Drink fluids, but do not force more than you can tolerate.
• Avoid anything that can cause cuts in the skin.
• Wash cuts and scrapes with soap and water every day, apply antibiotic ointment, and keep them covered until healed.
• Keep your body clean by bathing daily and washing your hands after using the bathroom.
• Avoid crowds, and don't visit with people who have infections, coughs, or fevers.
• Talk with your doctor or nurse about eating raw fruits and vegetables. Some suggest eating only cooked fruits and vegetables until the white blood cell counts come up again. If you eat raw foods, wash them carefully and peel them to avoid germs.
• Keep your mouth clean by brushing your teeth twice a day and flossing once a day (unless you were told not to floss).
• Use a stool softener to avoid constipation and straining during a bowel movement. Do not use enemas or suppositories of any kind. (See the section on constipation in this booklet.)
• If constipated, see the section in this booklet on constipation. Check with your doctor before using laxatives.
• Drink 2 to 3 quarts of liquid each day, if your doctor approves.

What caregivers can do

• Watch for shaking chills, and check the patient’s temperature after the shaking stops.
• Check the patient's temperature by placing the thermometer in the patient’s mouth or under his armpit. (Do not take a rectal temperature.)
• Encourage visitors who have fevers or the flu to visit the patient only by phone until they are well.
• Offer extra fluids.
• Help the patient take medicines on schedule.

Call the doctor if the patient:

• Has a temperature of more than 100.5° F when taken by mouth
• Has shaking chills
• Feels or seems "different" to others
• Cannot take fluids

Low platelet count

What to look for

• Bleeding from anywhere (such as mouth, nose, or rectum)
• New bruises on the skin
• Red rash that looks like pinpoint dots, usually starting on feet and legs
• Bad headaches, dizziness, or blurred vision
• Weakness that gets worse
• Pain in joints or muscles
• Vomiting blood or dark material that looks like coffee grounds
• Blood in stool (bright red, dark red, or black stools)
• More than the usual amount of vaginal bleeding during monthly periods

What the patient can do

• Use only an electric razor (not blade) for shaving.
• Avoid contact sports (such as wrestling, boxing, or football) and any other activities that might result in injury.
• Protect your skin from cuts, scrapes, and sharp objects.
• Use a soft toothbrush.
• If your mouth is bleeding, rinse it out with cold water.
• Talk to your doctor or nurse about whether you should put off flossing your teeth until platelet counts improve.
• Do not blow your nose or cough with great force.
• Stay upright; keep your head level with or above your heart.
• Avoid placing anything in the rectum, including suppositories, enemas, thermometers, etc.
• Stay away from anti-inflammatory pain medicines, such as naproxen or ibuprofen, or medicines that contain aspirin unless your doctor tells you to use them.
• If bleeding starts, stay calm. Sit or lie down and get help.

What caregivers can do

• For nosebleeds, have the patient sit up with head tilted forward, to keep blood from dripping down the back of the throat. Put ice on the nose and pinch the nostrils shut for 5 minutes before releasing them. Ice on the back of the neck may also help.
• For bleeding from other areas, press on the bleeding area with a clean, dry washcloth until bleeding stops.

Call the doctor if the patient:

• Has bleeding or any of the symptoms listed in the "What to look for" section above
• Has trouble speaking or moving

Go back to Caring for the Patient with Cancer at Home: A Guide for Patients and Families.

Last Medical Review: 04/27/2009
Last Revised: 04/27/2009