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BLOOD COUNTS AND YOUR IMMUNE SYSTEM

 I have heard that chemotherapy may cause drops in my blood counts. What does this mean?

 Bone marrow produces blood cells and releases them into the bloodstream, where they are able to protect the body in a variety of ways.

• White blood cells are cells in the blood that fight off infection and other types of disease; there are many different types of white blood cells, including neutrophils and lymphocytes.

• If you are cut or injured, platelets, also called thrombocytes, are blood cells that stop bleeding by clumping together, or clotting, to plug up damaged blood vessels.

• Red blood cells, also called erythrocytes, are cells in the blood that contain hemoglobin that carries oxygen from the lungs to all the tissues in the body; the cells use the oxygen to create energy. The number of cells in the blood can be measured by testing a blood sample for a complete blood count (CBC). The number of red cells is also reflected in measurements called hematocrit (the percentage of red cells in the blood) and hemoglobin (the amount of the molecule carrying the oxygen in the red cells).

The normal ranges for a CBC vary from laboratory to laboratory, but in general the normal values are as follows:

• White blood cells: 4-10,000 cells per cubic millimeter (cells/mm3)

• Platelets: 150,000–500,000 cells/mm3

• Hemoglobin: 12–18 g/dl

• Hematocrit: 36–54%

Once the bone marrow releases the blood cells into the bloodstream, they live for only a short time: as short as 24 hours for some types of white cells, about 10 days for platelets, and about 3 months for red cells. The body depends on the rapidly dividing cells in the bone marrow to continuously replace these cells as they die.

Chemotherapy destroys tumor cells by preventing them from dividing. However, normal cells that divide rapidly, such as those in the bone marrow, are also very sensitive to chemotherapy. The bone marrow loses the ability to form new blood cells; so fewer cells are released into the bloodstream, and the blood counts drop, generally 7 to 14 days after a chemotherapy treatment.

The white cells and platelets are particularly sensitive because they live only a short period of time. The body can adjust to slight decreases in the number of blood cells without any problem; however, your doctor will order a CBC before you get each cycle of chemotherapy to be sure that your counts are not too low. If your white cell or platelet count is too low, your doctor may decide to hold your treatment for a week to give the bone marrow a chance to make new blood cells.

Radiation therapy may also cause a drop in your blood cell counts if it is directed to an area that contains a large amount of active bone marrow, such as the pelvis, the ribs, or the spinal column. If there is a chance that your blood cell counts will drop during treatment, your doctor will order a CBC every week or two during your treatment.

What do I do if my white blood cell count is low?

If your white blood cell (WBC) count drops, the question is which types of white blood cells are low? The  doctor will order a CBC that lists the different types of white blood cells found and the number of each.

Neutrophils, a type of white blood cell that fights bacterial infection and other diseases, make up about 45-75% of your white blood cells. If the count is low, you have an increased risk of developing an infection.

Throughout your treatment, you can do certain things to prevent infection:

• Wash your hands frequently with soap and water, especially before eating and after going to the bathroom.

• Bathe daily with soap and water, and brush your teeth after each meal.

• Avoid people with colds or flu.

• Avoid sharing food utensils, drinking glasses, or toothbrushes.

• Avoid handling pet feces or urine, especially in cat litter or birdcage droppings.

• Check with your doctor or nurse before having any dental work or immunizations.

You can develop neutropenia, a decrease in the number of neutrophils, the type of white blood cell that fights bacterial infection and other diseases. In that event, your doctor or nurse may advise you to take extra precautions to prevent infection. In addition, your doctor may prescribe a medication called filgrastim (Neupogen®) or pegfilgrastim (Neulasta®) that can stimulate the bone marrow to make new white cells quickly. It is injected under your skin with a small thin needle. You or a family member may be taught to give the injection at home.

Despite doing all the right things, you may still develop an infection. If you have any implanted catheters or tubes (such as a port, a urinary stent, or a biliary stent) you have a higher than normal risk of developing an infection. You will not feel that your WBC count is low, so call your doctor or nurse if you develop any signs or symptoms of infection. You will most likely need to be examined and have tests taken to determine whether you require treatment with antibiotics.

Reasons to call the doctor:

• Fever of 100.5ºF (38ºC) or higher

• Shaking chills

• Sore throat or cough

• Frequency or burning when you urinate

• Swelling, redness, or pain anywhere on your skin

• Vomiting or diarrhea unrelated to your chemotherapy

To learn more about neutropenia and how to manage it, search on the following Internet sites:

• Oncology Nursing Society: www.cancersymptoms.org

• American Society of Clinical Oncology: www.cancer.net

• National Cancer Institute: www.cancer.gov

• American Cancer Society: www.cancer.org

What do I do if my platelet count is low?

If your platelet count drops, there is an increased risk of bleeding. Throughout your treatment, unless prescribed by your doctor, avoid aspirin, products that contain aspirin, and nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, because these may all interfere with platelet functioning. If the platelet count drops very low, your doctor or nurse may advise you to take extra precautions to prevent bleeding, such as using only an electric razor and avoiding activities in which you could be injured.

You will not feel that your platelet count is low; so call your doctor or nurse if you develop any signs or symptoms of bleeding.

Reasons to call the doctor:

• Easy bruising

• Bleeding gums or nosebleeds

• Blood in the urine or stool

• Black stools

What do I do if my red blood cell count is low?

If the red blood cell (RBC) count drops, you will feel fatigued. Fatigue can be experienced in many different ways: lacking energy; feeling tired, weak, or weary; feeling irritable or depressed; or having difficulty concentrating.

You may even feel lightheaded or short of breath. If the RBC count falls very low, your doctor may recommend a medication called epoetin (Procrit®, Epogen®) or darbepoetin (Aranesp®), which stimulates the bone marrow to make more red blood cells. It is given by injection under the skin using a very small thin needle. It comes in different doses and can be given either three times a week or once every 1 to 2 weeks.

Some people give themselves the injection; some people get it from their oncology nurse. You may also be instructed to take an iron supplement by mouth while getting these injections.

To learn more about anemia and how to manage fatigue, search on the following Internet sites:

• Oncology Nursing Society: www.cancersymptoms.org

• American Society of Clinical Oncology: www.cancer.net

• National Cancer Institute: www.cancer.gov

• American Cancer Society: www.cancer.org

Terms:

White blood cells - Cells in the blood that fight off infection and other types of disease; there are many different types of white blood cells, including neutrophils and lymphocytes; also called leukocytes.

Platelets - Cells in the blood that stop bleeding by clumping together, or clotting, to plug up damaged blood vessels; also called thrombocytes.

Red blood cells - Cells in the blood that contain hemoglobin that carries oxygen from the

lungs to all the tissues in the body, which the cells use to create energy; also called erythrocytes

Neutrophils - A type of white blood cell that fights infection and other diseases.

Neutropenia - A decrease in the number of neutrophils, the type of white blood cell that fights bacterial infection and other diseases.

Your doctor or nurse may advise you to take extra precautions to prevent infection.

 If your platelet count drops, there is an increased risk of bleeding.

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