During chemotherapy for breast cancer, a lot hinges on the blood test results that precede each treatment session. Low counts can indicate serious side effects, including fatigue, bruising, and vulnerability to infection -- and can also mean that treatment must be postponed until the body heals.
What a blood test can tell you about breast cancer treatment
Complete blood counts, or CBCs, are routinely performed before chemotherapy and other breast cancer treatments to check the number of each type of blood cell circulating in the body. This test is also called a hemogram.
In the simplest possible terms, white blood cells, or neutrophils, fight infection; red blood cells, also known as erythrocytes, pick up oxygen in the lungs and carry it to the tissues. CBCs note, among other things, any shortage of red blood cells, which is the definition of anemia and leads to low oxygen levels in the blood. In addition, CBCs count platelets, which are components of red blood cells that enable blood to clot.
Here's the shorthand:
- Low red blood count = fatigue, low energy
- Low platelets = bruising and bleeding
- Low white blood count = susceptibility to infection
What are normal ranges for CBCs?
These vary a bit depending on the lab, so the ranges that follow are guidelines rather than absolutes. Be sure to ask for a copy of the CBC each time it's performed, and look at the lab results sheet for the normal range for that lab. Still, there are some general rules of thumb:
Red blood cells (RBC)
Normal for men: 4.5 to 6.2 million per microliter (a s ingle drop)
Normal for women: 4.2 to 5.4 million per microliter
White blood cells
Normal for men and women: 3,700 to 10,000 per microliter
Lowest level at which patients are safe from infection: 1,000
Normal range for men and women: 150,000 to 450,000 per microliter
Lowest level at which blood can still clot normally: 100,000
Level at which there's a risk of spontaneous bleeding: 50,000
Level at which bleeding can become life-threatening: 5,000
What happens when the red blood count is low?
Hemoglobin, the protein in red blood cells that oxygenates the blood, provides the body with energy, strength, and stamina. When there isn't eno ugh oxygen in the blood, you feel tired, weak, and sometimes faint or dizzy. It's hard to catch your breath, or you may feel pain in the chest when you try to breathe. Extreme fatigue can bring with it memory or concentration problems, leading to mental confusion. For more information, see Understanding Low Red Blood Counts .
What happens when the platelet count is low?
Platelets control clotting and stop bleeding, so when platelets are low, you bruise easily and bleeding doesn't stop easily even after a minor cut or scratch. (Women who are still having periods may have unusually heavy flow.) Nosebleeds and bleeding gums after brushing teeth can become an ongoing problem. Some people also get a rash that looks like little pinprick-sized red or purple dots, or they experience aching in their joints or muscles. Headaches are common too. For more information, see Understanding Low Platelets .
What happens when the white blood count is low?
The technical name for this is neutropenia, from the word neutrophil, and it means that the immune system is depressed. Another term you may hear is immunocompromised. Without regular immune function, the body can't fight off germs and infections as it normally would. Watch closely for signs of fever, sore throat or cough, or chills and shaking. Keep an eye out for other signs of infection, such as an injury that gets red and pus-filled or doesn't heal. Another sign is diarrhea or loose stools for more than two days in a row. On the opposite extreme, an overly high white blood count is a sign the body is fighting an infection, although those fighting leukemia also can have elevated white counts.
At what levels is there cause for alarm?
Because the ranges considered normal are very wide, interpretation of the results can get muddy. One patient with a platelet count of 100,000 might have only minor bruising, for example, while another might have constant nosebleeds. It's also important to keep in mind that blood counts are low as a result of chemotherapy and will rise again as the body manufactures new cells.
Most of the time, it's simply a case of waiting for the counts to rise again and taking extra steps to stay safe in the meantime. However, for each count there is a level below which the doctor will take steps to elevate blood counts. These may include prescribing medicines or giving transfusions. Likewise, don't be surprised if the doctor postpones a chemo treatment if she decides the blood counts are too low.