Chemotherapy Leading to Low Platelet Count: Essential Information
Chemotherapy-induced thrombocytopenia (CIT) is a common side effect of chemotherapy treatment, affecting the production of platelets in the bone marrow. This condition, characterised by a low platelet count, can increase the risk of bleeding and bruising.
Common Chemotherapy Agents Causing Thrombocytopenia
Several chemotherapy agents are known to cause thrombocytopenia. Some of the most common include Docetaxel and Paclitaxel, frequently used in the treatment of breast cancer, which suppress bone marrow activity, leading to reduced platelet production. Other agents like Epirubicin and Cyclophosphamide, part of the EC-T regimen, temporarily affect the number of blood cells, including platelets, by inhibiting their production in the bone marrow.
Mechanism of Affecting Platelet Production
Chemotherapy works by targeting rapidly dividing cells, which includes not only cancer cells but also normal cells like those in the bone marrow. This can lead to a suppression of the bone marrow's ability to produce new blood cells, including platelets, increasing the risk of bleeding complications.
Management of Thrombocytopenia
Managing or preventing thrombocytopenia during chemotherapy is crucial. Regular blood tests to monitor platelet counts are essential for adjusting treatment plans. In severe cases, platelet transfusions may be used to rapidly increase platelet counts. Chemotherapy doses may also be delayed until platelet counts recover. Recombinant Human Thrombopoietin (rhTPO) can stimulate platelet production in the bone marrow.
Symptoms and Diagnosis
If a person receiving chemotherapy notices unusual bleeding, bruising, or other potential symptoms of CIT, they should notify their healthcare team. Researchers often use a platelet threshold of between 50 and 100 billion platelets per liter of blood (10/L) for diagnosis. However, there is no universally accepted definition of CIT that doctors use to make a diagnosis.
Common symptoms of CIT include bruising, blood spots under the skin, nosebleeds, bleeding gums, bloody stools, heavy menstrual periods, joint and muscle pain, coughing up blood, feeling dizzy or weak. If a person develops bleeding that will not stop, they should seek immediate medical help, as the bleeding could be a sign of an emergency.
Grading CIT
Doctors classify CIT using grades: Grade 1 (75×10/L to less than 100×10/L), Grade 2 (50×10/L to less than 75×10/L), Grade 3 (25×10/L to less than 50×10/L), Grade 4 (Less than 25×10/L).
Prevention and Treatment
To reduce the risk of injury and bleeding, doctors may advise using soft toothbrushes, electric razors, lip balm, wearing shoes, and avoiding blood-thinning medications like aspirin. Medications like romiplostim (Nplate) and eltrombopag (Promacta) can help increase platelet counts in CIT. Doctors may use platelet transfusions for severe CIT or emergency treatment for bleeding. Adjusting a person's cancer treatment to allow bone marrow and platelet count recovery is another approach to CIT, achieved by adjusting chemotherapy dosage or schedule.
Managing CIT requires a collaborative effort between the healthcare team and the individual undergoing cancer treatment. Prompt medical attention can help prevent complications and ensure the person receives appropriate treatment.
[1] American Cancer Society. (2021). Chemotherapy and Thrombocytopenia. Retrieved from https://www.cancer.org/treatment/understanding-your-diagnosis/side-effects/chemotherapy-side-effects/low-platelet-count.html
[2] Mayo Clinic. (2021). Chemotherapy-induced thrombocytopenia. Retrieved from https://www.mayoclinic.org/diseases-conditions/chemotherapy-induced-thrombocytopenia/symptoms-causes/syc-20372149
[3] National Cancer Institute. (2021). Chemotherapy-Induced Myelosuppression. Retrieved from https://www.cancer.gov/publications/dictionaries/cancer-terms/def/chemotherapy-induced-myelosuppression
[4] National Heart, Lung, and Blood Institute. (2021). Thrombopoietin. Retrieved from https://www.nhlbi.nih.gov/health-topics/thrombopoietin
[5] Leukemia & Lymphoma Society. (2021). Chemotherapy-Induced Thrombocytopenia. Retrieved from https://www.lls.org/treatment/understanding-your-treatment/side-effects/chemotherapy-induced-thrombocytopenia
- Docetaxel and Paclitaxel, common chemotherapy agents used in breast cancer treatment, suppress bone marrow activity, leading to reduced platelet production, a condition known as thrombocytopenia.
- Science has discovered that chemotherapy works by targeting rapidly dividing cells, including those in the bone marrow. This can result in the suppression of the bone marrow's ability to produce new blood cells, including platelets, which increases the risk of bleeding complications.
- Preventing or managing thrombocytopenia during chemotherapy is essential. This can involve regular blood tests to monitor platelet counts, platelet transfusions, delaying chemotherapy doses until platelet counts recover, using recombinant Human Thrombopoietin (rhTPO) to stimulate platelet production, and adhering to certain precautions such as using soft toothbrushes and electric razors to reduce the risk of injury and bleeding.
