Breast cancer patients need to monitor platelet levels carefully
A common side effect of chemotherapy or radiation for breast cancer treatment is a drop in platelet count, also known as thrombocytopenia. And because platelets help make blood clot, having too few of them can lead to uncontrolled bleeding. (For more information on this problem, see Understanding Low Platelets.) Here's how to cope when platelet count drops too low.
Whenever platelet levels drop below 50,000 per microliter of blood, it's considered a risk for excessive bleeding. If levels drop below 10,000, immediate medical attention is needed. (For more information on blood counts, see Understanding Low Red Blood Counts.) Between 50,000 and 10,000, though, you'll be playing the waiting game, watching to see if platelet counts begin to rise, while protecting someone you're caring for from injury.
Protection from bleeding risks due to low platelets.
Start by thinking through the daily activities of the person you're caring for, looking for any that might pose an injury risk. Then advise her to take these precautions to prevent bleeding:
- Assign someone else to do the cutting and chopping in the kitchen.
- Always wear gloves while gardening or working with tools. (If possible, find someone else to do minor repairs around the house.)
- Avoid activities that could lead to injury, such as bicycling.
- Allow someone else to cut toenails and fingernails, especially if neuropathy is affecting hand coordination.
- Wear shoes or slippers at all times for foot protection.
- Don't use razors (use an electric shaver instead).
- Use a soft-bristle toothbrush.
- Don't use dental floss.
- Rinse after meals with an alcohol-free mouthwash or baking soda solution (2 teaspoons baking soda to 8 ounces water).
- Make sure dentures fit properly.
- Use lip balm to prevent lips from becoming dry and cracking.
- Use sanitary pads rather than tampons during menstruation.
Protect against bruising caused by low platelets.
When platelets are low, bruises start showing up everywhere. Sometimes the person you're caring for won't even know what caused them. Take a preventive approach by moving furniture that's easy to bump into, taking up or taping down rugs that someone could trip over, and looking the house over for other falling or tripping risks. Now might be a good time to install handrails in the shower, for example.
Other precautions for cancer patients when platelet count is low
Choose pain medication carefully. Many anti-inflammatory pain medicines thin the blood, which is the opposite of what you want to happen when platelet counts are low. Instead, if the person you're caring for needs an over-the-counter pain medication (and the doctor has said it's okay), stick to acetaminophen and avoid aspirin and ibuprofen. Read labels carefully and beware of combination drugs that include aspirin or ibuprofen.
Treat head colds proactively. A stuffy nose is a problem for anyone with low platelets, because nose blowing can lead to nosebleeds. When battling a cold or cough, check with the doctor about whether to use decongestants or other cold or cough remedies.
Prevent bleeding in the digestive tract. Low platelets can lead to rectal bleeding and bleeding in the digestive tract, so it's important to take precautions against constipation and hemorrhoids. Straining during a bowel movement not only leads to hemorrhoids; it can actually increase pressure around the brain, leading to a greater risk of hemorrhage, as well. Some helpful strategies:
- Eat a diet with plenty of fiber, such as whole grains and fruit
- Take a fiber supplement, if necessary, to boost fiber intake
- Avoid coarse, raw vegetables that can injure the digestive tract
- Drink eight to ten glasses of water daily
- Take a laxative, if still necessary after all of the above, to avoid constipation
Apply pressure to stop bleeding when it occurs. In the case of a cut or nosebleed, you'll want to stop the bleeding as quickly as possible; this can take much longer than normal when platelet counts are low.
For a cut or scrape, apply firm pressure with a clean cloth or bandage for at least five minutes, longer if necessary. For a nosebleed, apply firm pressure just below the bridge of the nose for as long as it takes for the nosebleed to stop. If bleeding doesn't stop after more than ten minutes, call the doctor.
Set up an alarm system for injuries. If you're caring for someone who doesn't have a partner or live-in caregiver, it's a good idea to set up an alert system that she can set off if she injures herself. Since even minor bleeding can turn serious very quickly for someone with a low platelet count, remind her that she'll need to go to the emergency room for any injury that causes uncontrolled bleeding.
Get treatment if platelet count drops too low. If platelet counts drop dangerously low, the doctor can order treatment with platelet infusions. However, the benefits of platelet transfusion last only a few days and have diminishing effectiveness over time, so oncologists typically recommend this option only when there's a serious and urgent risk of uncontrollable bleeding. For more information, see