A drop in platelet count, also known as thrombocytopenia, is a common side effect of chemotherapy or radiation for cancer treatment. 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.
Monitor platelet levels carefully.
Whenever a patient's platelet levels drop below 50,000 per microliter of blood, he's considered at risk for excessive bleeding. If his level drops below 10,000, he's in need of immediate medical attention. (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 his platelet count begins to rise, while protecting him from injury.
Protect cancer patients from bleeding risks due to low platelets.
Start by thinking through the patient's daily activities, looking for any that might put him at risk for injury. Then discuss ways he can take precautions to prevent bleeding:
- Assign someone else to do the cutting and chopping in the kitchen.
- Always wear gloves while gardening a nd also while working with tools. (If he likes to do minor repairs around the house, see if you can talk him into letting someone else handle the hammer for now.)
- Avoid activities that could lead to injury, such as bicycling.
- Allow someone else to cut toenails and fingernails, especially if neuropathy is affecting his 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.
- Encourage him to rinse his mouth 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 his lips from becoming dry and cracking.
- For a woman who still has periods, 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 you won't even know what caused them. Take a preventive approach by moving furniture that's easy to bump into, taking up (or taping dow n) rugs that the person in your care 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 bathtub, for instance.
Choose pain medication carefully
Many anti-inflammatory pain medicines thin the blood, which is the opposite of what you want to happen if platelet counts are low. If an over-the-counter pain medication is needed, 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 someone with low platelets, because blowing his nose can lead to nosebleeds. If he gets a cold, check with his do ctor about whether to use decongestants or other cold remedies. If he develops a cough, the doctor may recommend using cough syrup.
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 risk of hemorrhage as well. Make sure the person in your care is:
- Eating a diet with plenty of fiber, such as whole grains and fruit
- Taking a fiber supplemen t, if necessary, to boost fiber intake
- Avoiding coarse, raw vegetables the could injure his digestive tract
- Drinking eight to ten glasses of water daily
- Taking a laxative, if still necessary after all of the above, to avoid constipation
Apply pressure to stop bleeding when it occurs -- and set up an alarm system for injuries.
If the person in your care gets a cut or a nosebleed, you'll want to stop the bleeding as quickly as possible; this can take much longer than normal when his platelet count is low.
For a cut or scrape, apply firm pressure with a clean cloth or bandage for at least five minutes, longer if necessary. If he gets a nosebleed, apply firm pressure just below the bridge of his nose for as long as it takes for the nosebleed to stop. If bleeding doesn't stop after more than ten minutes, call
If he doesn't have a partner or live-in caregiver, it's a good idea to set up an alert system that he can set off if he injures himself. Since even minor bleeding can turn serious very quickly for someone with a low platelet count, he'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 drops dangerously low, his doctor can order treatment with p latelet infusions. However, the benefits of platelet transfusion last only a few days, so oncologists typically recommend this option only when there's a serious and urgent risk of uncontrollable bleeding. For more information, see Why won't the doctor order a blood transfusion to boost platelets?