A Guide to Chemotherapy

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Hair loss from chemo

Increased chance of bruising, bleeding, infection, and anemia after chemo

Chemo often causes decreases in your blood cell counts. Blood cells are made in the bone marrow. Three important parts of your blood affected by chemo are:

  • Platelets, which help blood to clot and stop bleeding
  • White blood cells, which fight infection
  • Red blood cells, which carry oxygen to cells

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

Your doctor will check your blood cell count by doing a test called a complete blood count or CBC. This will be done often during your treatment.

Bleeding or clotting problems

Platelets are the blood cells that help stop bleeding by plugging up damaged blood vessels and helping your blood to clot. If you don’t have enough platelets, you may bleed or bruise more easily than usual, even from a minor injury. A shortage of platelets is called thrombocytopenia (THROM-bo-SY-toe-PEEN-ee-uh).

Report these signs of thrombocytopenia to your doctor:

  • Unexpected bruising
  • Small flat red spots under your skin
  • Red or pink urine
  • Black or bloody bowel movements
  • Any bleeding from your gums or nose
  • Bad headaches
  • Dizziness
  • 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. There’s nothing you can do to help increase your platelet count, but there are some precautions you can take:

  • Don’t take any medicine without first checking with your doctor or nurse. This includes aspirin and aspirin-free pain relievers, like acetaminophen (Tylenol®), ibuprofen, and any other medicines you can buy without a prescription. Some of these medicines can make bleeding problems worse.
  • Don’t drink any alcohol (beer, wine, or liquor) unless your doctor says it’s OK.
  • Use an extra-soft bristle 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 rather than a potholder when you reach into the oven.
  • Avoid contact sports and other activities that might cause an injury.
  • Drink plenty of fluids and eat enough fiber to reduce your chances of getting constipated.
  • Use an electric shaver instead of a razor.
  • When bending over, keep your head above your heart.


A low white blood cell count decreases your ability to fight infections. One type of white blood cell, called the neutrophil (NEW-trow-fill), is especially important in fighting infections. A shortage of neutrophils is called neutropenia (NEW-trow-PEEN-ee-uh).

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 hold treatment, give you a lower dose of chemo, or, in some cases, give you a growth factor shot that makes your bone marrow produce more white blood cells. When the chemo used is known to cause very low white blood cell counts, growth factor shots may be used to help keep this from happening.

While there’s nothing you can do to raise your white blood cell counts on your own, you can do things to help prevent infection, such as:

  • Wash your hands often during the day, especially before you eat and after you use the bathroom.
  • Stay away from crowds.
  • Stay away from people who have diseases you can catch, such as colds, flu, measles, or chicken pox.
  • Do not get any immunization shots (vaccines) without first checking with your cancer doctor.
  • Stay away from people who have recently had an immunization, such as a vaccine for chicken pox or small pox. 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 very well but gently after each bowel movement. Ask your doctor or nurse for advice if the area becomes sore 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 bristle 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, scrapes, and broken skin right away with warm water and soap. Use an antibiotic ointment and cover with a bandage.
  • Wear waterproof gloves when gardening or cleaning up after animals and others, especially small children. Wash your hands afterward, since gloves can have holes that are too small to see.

Even if you are 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 of infection. Pay special attention to your eyes, nose, mouth, and genital and rectal areas. Symptoms of infection could be:

  • Fever of 100.5°F or greater when your temperature is taken by mouth
  • Chills
  • Sweating
  • Loose stools (This can also be a side effect of chemo.)
  • A burning feeling when you urinate
  • A bad cough or sore throat
  • Unusual vaginal discharge or itching
  • Redness, swelling, or tenderness, especially around a wound, sore, pimple, IV site, or central venous catheter
  • Abdominal (belly) pain

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

For much more detail on the immune system, infections and cancer, and how to prevent them, please see Infections in People With Cancer. It can be read online, or call us for a free copy.


Anemia (uh-NEE-me-uh) is when you have too few red blood cells, and your body tissues don’t get enough oxygen to do their work. You may have these symptoms:

  • Extreme tiredness (fatigue)
  • Dizziness
  • Pale skin
  • A tendency to feel cold
  • Shortness of breath
  • Weakness
  • Racing heart

You can’t do anything to increase your red blood cell counts, but there are things that may help with anemia. Try the ideas listed in the section called “Fatigue from chemoif your anemia is making you feel very tired. Let your doctor or nurse know if you have any of the symptoms listed above.

If your red blood cell count falls too low, you may need a blood transfusion. Some people can be treated with a growth factor – a drug used to boost the number of red blood cells the bone marrow makes.

You can get a lot more information in Anemia in People With Cancer. Call for a free copy, or read it on our website.

Last Medical Review: 06/09/2015
Last Revised: 06/09/2015