When Your Blood Counts are Low

Your blood counts will drop after chemotherapy and/or radiation. This is to be expected. Your blood counts will start to rise about one to two weeks after your conditioning regimen is completed. However, every patient is unique, and blood counts may take longer to recover in some patients. If you have any questions or concerns about your blood count recovery, you should discuss them with your doctor.

White Blood Cells: Infection

After you receive your conditioning therapy, your white blood count will decrease and remain low until your new cells begin to grow. During this period of engraftment, you are at risk of developing infections because you do not have white cells to fight these bacteria, viruses or fungi.

Bacterial Infections

Bacteria are microscopic organisms that invade tissues and multiply rapidly. They can cause infections anywhere in the body.

Bacterial infections are most common during the first two to four weeks following a transplant. The chemotherapy and/or radiation administered before transplant impairs your ability to fight bacterial infections in three ways:
The skin and mucous membrane barriers that normally prevent bacteria from entering the body are damaged.
Neutrophils that are responsible for fighting bacteria are destroyed.
Antibodies that once made you immune to certain bacterial infections are depleted.

Post-transplant infections occur most often in the intestines, the skin (especially around long-term IV catheters), and in the mouth. They also can occur in the bladder or in the lungs, causing pneumonia.

Fungal Infections

Fungi are primitive life forms we encounter every day. Bread mold is a common fungus. Most are harmless, and some, such as Candida, normally reside in our bodies. Fungal infections are very difficult to detect and treat. Candida and Aspergillus infections are the most common fungal infections after transplant. Candida fungi live in the intestines, mouth and vagina; normally, they are kept in check by bacteria. When antibiotics destroy bacteria, fungi can multiply and spread, infecting many parts of the body. Aspergillus infections occur most often in the sinus passages or in the lungs and can cause pneumonia.

Viral Infections

Viruses are tiny parasites that must invade other organisms, such as human cells, to survive and multiply. Viruses eventually destroy or cripple the host cell and move on to neighboring cells to continue reproduction and destruction.

Viral infections are difficult to treat, but anti-viral agents are available.

Viral infections after a transplant can occur either as a result of exposure to a new virus or reactivation of an old virus dormant in your body. Viral infections are most common during the first 12 months following a BMT, but may occur as late as two years after transplant. The most common ones are caused by herpes simplex virus (cold sores, shingles), cytomegalovirus and varicella zoster virus (chicken pox).

To help avoid infection while your WBC count is low – below 1,000 – you will need to do the following:

  • Bathe or shower daily.
  • Perform good mouth care using a Toothette® oral swab and follow your oral care instructions.
  • Follow a low-bacteria diet, a copy of which will be provided to you.
  • Avoid contact with people who have a cold, flu, chicken pox and other contagious diseases (you may need to limit visitors who are not feeling well).
  • Eliminate plants, fresh flowers and fresh fruit from your room.
  • Take all medications.
  • Wash your hands well before mouth care, eating and after using the bathroom.

If you develop an infection during this time period, you will be placed on antibiotics immediately.  It is important to tell your nurse or doctor how you are feeling. Some of the symptoms of an infection are:

  • Fever
  • Skin tenderness
  • Chills/sweating
  • A burning feeling when urinating
  • Rectal pain/tenderness
  • A cough, sore throat or mouth pain
  • Loose stools/diarrhea

Platelets: Bleeding

Because platelets are made in the bone marrow, your platelet count will begin to rise as the marrow grows back. It usually takes platelets a few weeks longer to grow back than the WBCs and RBCs.

Common symptoms of a low platelet count are:

  • Nose bleeds
  • Bleeding around the teeth and gums 
  • Blood in the urine or stool (which may not be seen by the eye)
  • Small bruises on the body

It is important for you to tell your doctor or nurse if you notice anything different or any bleeding.  During this time, there are things you can do to prevent bleeding:

  • Take good care of your skin and lips; dryness may lead to bleeding.
  • Use only an electric razor.
  • Wear shoes or slippers at all times when you are out of bed.
  • Avoid blowing your nose vigorously and picking your nose.
  • Avoid deep coughing or sneezing. 
  • Avoid straining during bowel movements and vomiting.
  • Exercise by walking; avoid rough activity or exercises that may cause you to bump your head or injure other parts of your body.
  • Report headaches and lightheadedness to your nurse.
  • Take special care with hot foods or sharp utensils so you don’t injure your mouth; do not use toothpicks, toothbrushes or dental floss.
  • Avoid clipping your finger and toe nails without the permission of your nurse or doctor.
  • Please remember to save all your urine and stool in designated containers so that the nurse can test for traces of blood.

Red Blood Cells: Fatigue

When your red blood cell counts drop, you may require red blood cell transfusions to treat your anemia. Symptoms of anemia include:

  • Shortness of breath 
  • Pale color
  • Weakness
  • Fatigue
  • Irritability
  • Feeling cold
  • Dizziness

If these symptoms occur, notify your doctor or nurse.

There are several things you can do to help yourself feel better while you are anemic:

  • Conserve your energy and take frequent naps between activities.
  • Move slowly and change positions slowly to avoid dizziness.