Bleeding or Low Platelet Count
Cancer and cancer treatments can lower the number of platelets in your blood. Platelets are cells that help your blood clot, so you stop bleeding.
A normal platelet (PLT) count on a blood test is about 150,000 to 450,000. Normal clotting is still possible with a platelet count of 100,000. The risk of serious bleeding is very high when the platelet count goes below 20,000.
What to look for
- Bleeding from anywhere (such as the mouth, nose, or rectum)
- Bloody or dark brown vomit that looks like coffee grounds
- Bright red, dark red, or black stools (poop) (see Blood in stool for more on this)
- Red, pink, or brown urine (see Blood in urine for more on this)
- Women may have heavy vaginal bleeding during monthly periods
- New bruises on the skin
- Red pinpoint dots on the skin, usually starting on feet and legs
- Bad headaches, dizziness, or blurred vision
- Weakness that gets worse
- Pain in joints or muscles
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 lead to injury.
- Protect your skin from cuts, scrapes, and sharp objects.
- Use a soft toothbrush.
- If your mouth is bleeding, rinse it a few times with ice water.
- Talk to your cancer team about whether you should put off flossing your teeth until your platelet counts improve.
- Do not blow your nose or cough with great force.
- Keep your head level with or above your heart (lie flat or stay upright).
- Use a stool softener to avoid constipation and straining during a bowel movement. Do not use enemas or suppositories of any kind. Check with your cancer team before using laxatives.
- Do not put anything in your rectum, including suppositories, enemas, thermometers, etc.
- Stay away from anti-inflammatory pain medicines, such as aspirin, naproxen, or ibuprofen (Motrin®, Advil®, Naprosyn®, Aleve®, Midol®) and medicines like them unless your cancer team tells you to use them. Check with your pharmacist if you’re not sure whether a medicine is in this class of drugs, or if it contains one of 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 or paper towel until bleeding stops.
Call the cancer team if the patient:
- Is bleeding or has any of the symptoms listed in the “What to look for” section
- Has trouble speaking or moving
Fauci AS, Braunwald E, Kasper DL, et al (Eds). Harrison’s Principles of Internal Medicine, 17th ed. New York: McGraw-Hill Medical, 2008.
Camp-Sorrell D, Hawkins RA. Clinical Manual for the Oncology Advanced Practice Nurse, Second Ed. Pittsburgh: Oncology Nursing Society, 2006.
Cope DG, Reb AM. An Evidence-Based Approach to the Treatment and Care of the Older Adult with Cancer. Pittsburgh: Oncology Nursing Society, 2006.
Houts PS, Bucher JA. Caregiving, Revised ed. Atlanta: American Cancer Society, 2003.
Kaplan M. Understanding and Managing Oncologic Emergencies: A Resource for Nurses. Pittsburgh: Oncology Nursing Society, 2006.
Kuebler KK, Berry PH, Heidrich DE. End-of-Life Care: Clinical Practice Guidelines. Philadelphia: W.B. Saunders Co. 2002.
National Comprehensive Cancer Network. Palliative Care. Version 1.2015. Accessed at www.nccn.org/professionals/physician_gls/pdf/palliative.pdf on March 19, 2015.
Oncology Nursing Society. Cancer Symptoms. Accessed at www.cancersymptoms.org on April 3, 2013.
Ripamonti C, Bruera E. Gastrointestinal Symptoms in Advanced Cancer Patients. New York: Oxford University Press, 2002.
Varricchio CG. A Cancer Source Book for Nurses, 8th ed. Sudbury, MA: Jones and Bartlett, 2004.
Yarbro CH, Frogge MH, Goodman M. Cancer Symptom Management, 3rd ed. Sudbury, MA: Jones and Bartlett, 2004.
Last Medical Review: June 8, 2015 Last Revised: February 13, 2017