Low
Blood Counts
While on chemotherapy, your oncologist will be monitoring your blood
counts with a complete blood count (CBC).
Most often checked are the white blood cell count (WBC), the absolute
neutrophil /granulocytes count (ANC, GRAN or GR#), the red blood cell
count along with the hemoglobin and hematocrit. ANC is important
as it is the component of the WBC that fights infection.
Hemoglobin is important as a low level indicates anemia and contributes
to a feeling of fatigue. Platelets are the third item looked at and a
low platelet count is termed thrombocytopenia.
A low WBC/ANC can be treated using drugs such as
Filgrastim (Neupogen®),
Peg - Filgrastim (Neulasta®), and Sargramostim (Leukine®). Low hemoglobin/low hematocrit can be treated with drugs
such as Procrit and Aranesp.
Low platelets (thrombocytopenia) lacks
bone marrow supportive drugs. Neumega® (oprelvekin) is a drug currently on the market, but
most oncologists are reluctant to use it due to side effects.
Therefore, current therapeutic options are mostly palliative,
including steroids, immunosuppresants, splenectomy and, for the most
severe thrombocytopenias, platelet transfusion. Sometimes treatment is delayed while waiting for platelets to recover.
Also, the dose of chemotherapy can be lowered. New drugs are being
developed for low platelets which in time, might help chemotherapy
patients. The FDA recently approved
Nplate
(romiplostim) for ITP. The
approval is for long term treatment of adult chronic ITP. It is not
yet approved for treating standard thrombocytopenia. Another drug, also
recently approved is
Promacta (eltrombopag).
Low white blood counts, especially the infection
fighting component of neutrophils, can lead to neutropenic fever. A
patient in Canada was provided with the following form letter to take to
the emergency room if their temperature were to exceed 38 deg C or 100.5
deg F. He was given this before his 1st taxotere infusion. Note: for a
thorough discussion of neutropenic fever, see the page at
chemocare on managing neutropenic fever.
Empiric Febrile Neutropenic Guidelines for
Adults (Canadian)
"This patient is currently receiving
chemotherapy. It is possible he will develop a fever associated with
neutropenia. Fever associated with neutropenia can be a life
threatening complication. Patients can die within hours of sepsis, if
not treated with appropriate antibiotics.
If this person presents to you with a fever of
38 C, a CBC including absolute neutrophil count (ANC) should be
requested immediately. The total white blood cell count alone does not
provide accurate enough information.
If the ANC is less than 0.5 and 1.0, the patient
should either be observed closely with repeat daily blood counts to
ensure they are not entering the nadir period, or should be treated as
above if they appear unwell.
We currently recommend Cefotaime 2 gram I.V. q8h
and Gentamicin q24h (dosing based on creatinine and weight). It is
essential that the antibiotics he is placed on are broad spectrum and
cover gram-negative organisms effectively. Alternate acceptable choices
include: ceftazidime, meropenem, in conjunction with gentamicin or
tobramycin. We place our patients on protective isolation, but gowns,
masks and gloves are not required."
His wife relates, "Bob did have a fever of over
38C after the first taxotere treatment. It occurred during the night
and I took him and this form letter to our nearest ER and they followed
these instructions. The X-ray did show a spot on his lungs which
disappeared after these antibiotics were finished. I was glad to have
this letter."
A graph of WBC(white blood count) and GRAN(granulocytes) and how
they are impacted by weekly single agent taxotere and by Novantrone (every
3 weeks) illustrates the effect of chemotherapy on white blood counts.
The
chemocare website provides a well written page on Low Blood Counts
Low Blood Counts Excerpt from the booklet
"Choices"
|
This
section is an excerpt of an excellent booklet called "Choices:
Living with cancer, dying with dignity." Molly Sower Sugarman
wrote this booklet in honor of her husband, Matthew, who died
of prostate cancer in 1999. The Rotary Clubs of District 5190,
generously funded the publication of this brochure. Molly and
the Rotary Club have given permission to reprint this section.
You can obtain a complete copy of the brochure by sending an
e-mail request to Molly at
mssugarman@gmail.com
or by reading the copy at the
PSA-Rising
website. |
INTRODUCTION
If
cancer affects your bone marrow, the marrow will produce fewer and fewer
of the blood cells essential to your well being.
Too
few red blood cells causes fatigue and breathlessness. The bone marrow
produces red blood cells, which carry oxygen. With too few red blood
cells, your body does not have enough oxygen. Giving you oxygen may
not be a solution. It is not lack of oxygen intake that is causing the
problem; it is lack of cells to carry the oxygen.
Low
white-cell counts increase your risk of infection. Too few platelets
reduces the ability of blood to clot.
Low
blood counts may be caused by treatment, such as radiation. The effects
on your bone marrow may wear off over time and the cell counts may go
up again. Low blood counts may also result when cancer destroys the
cell-making capacity of the bone marrow or when the cancer kills blood
cells faster than the marrow can make new ones.
If
the cancer has destroyed the bone marrow’s ability to produce blood
cells, palliative measures are available to help maintain your quality
of life but these measures will not cure the problem.
PALLIATIVE
MEASURES
If
blood counts are low due to treatments, such as radiation, medication
may "jump start" the bone marrow. Usually the medicine is
given in a series of injections. You may be able to give the injections
yourself. If this is successful, the blood counts will rise and the
symptoms—breathlessness and fatigue—may lessen.
Eventually,
the toxic effect of the cancer on all body systems may increase, making
fatigue and breathlessness unavoidable. You may be less able to perform
daily tasks simply because you don’t have the energy.
Blood
transfusions can increase the number of red blood cells available to
carry oxygen. Your doctor can test your blood on a regular basis and,
if the cell counts are low, order the transfusion of whatever amount
of blood he or she feels will reduce your fatigue.
Because
the bone marrow is not replenishing the red cells naturally, this outside
replenishment may be ordered repeatedly, on a monthly or more frequent
basis, as needed. When blood transfusions are required frequently, you
may want to consider whether the time spent traveling to the medical
center and getting the treatment is worth the benefit received. This
is one of the many choices you have to make between treatment and quality
of life.
Ask
your doctor about options to minimize the effects of low blood counts
or what help hospice care might offer.
LIFESTYLE
CONSIDERATIONS
Techniques
for dealing with the fatigue and the breathlessness of low red blood
counts are discuss in the section "Fatigue."
White
blood cells cannot be transfused. Because of the increased risk of infection
when white counts are low, your doctor may suggest immunizations for
flu and pneumonia, or avoiding people who have contagious diseases.
You will want to pay attention to health alerts aimed at people with
reduced immune systems. Report any fever to your doctor for early antibiotic
therapy, if needed.
Low
platelet counts may cause problems with clotting and reduce the body’s
ability to stop bleeding, even from minor cuts and scrapes, such as
those that occur while shaving. Tell your doctor about any sign of bleeding,
such as a nosebleed or blood in your urine or stool.
You
may bruise more easily. If this happens, you may want to talk to your
doctor about medicines, food or herbs that increase the clotting ability
of blood.
Molly
Sower Sugarman
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