Managing bone marrow suppression

What is bone marrow suppression?

Nearly all chemotherapy agents cause a reduction of blood cell counts. When this reduction occurs varies, according to which agents are used for your child's treatment. Red blood cells that carry oxygen, white blood cells that fight infection and platelets that control bleeding are usually lowered with chemotherapy use. Risk for anemia, fatigue, infection and bleeding are increased with bone marrow suppression. Common terms that you may hear that refer to blood cell reduction include the following:

• Anemia - decrease in red blood cells
• Neutropenia - decrease in neutrophils (a specific type of white blood cell; a main defender of bacteria)
• Thrombocytopenia - decrease in platelet counts
• Pancytopenia - decrease in red blood cells, white blood cells and platelets

While your child is undergoing chemotherapy treatment, these blood cell levels will be monitored frequently. Many parents like to keep track of their child's blood counts to record their progress. Ask your child's physician what levels are acceptable for your child.

What are symptoms of bone marrow suppression?

The following are the most common symptoms of bone marrow suppression. However, each child may experience symptoms differently. Symptoms may include:

Low platelets:

• Easy bruising
• Bleeding: nose bleeds, gums or mouth
• Tiny red spots on the skin (petechiae)
• Blood in the urine
• Dark or black bowel movements

Low white blood cells:

• Fever and chills
• Rash
• Diarrhea
• Signs of infection (anywhere in the body):
  • Swelling
  • Redness
  • An area that is warm to touch

Low red blood cells:

• Fatigue
• Paleness of skin, lips and nail beds
• Increased heart rate
• Tires easily with exertion
• Dizziness
• Shortness of breath

Treatment and prevention to manage bone marrow suppression

There are several things you can do for your child to prevent complications of bone marrow suppression. Your child may be given specific medications to help stimulate the production of cells in the bone marrow. While you are waiting for your child's blood counts to return to a healthy range, consider the following:

• Your child should avoid strenuous activity, contact sports or heavy lifting
• Avoid having your child blow their nose or forcefully cough
• Avoid harsh, raw vegetables, or foods with rough surfaces in your child's diet
• Avoid allowing your child to consume alcohol
• Encourage your child to eat high-protein foods
• Have your child use an antiseptic mouthwash without alcohol
• Encourage your child to drink plenty of fluids
• Keep all scratches clean and covered
• Girls should not shave their legs or underarms; boys should not shave facial hair
• Make sure your child, and anyone who comes in close contact with your child, washes hands frequently
• Avoid uncooked fruits and vegetables, as they can transmit bacteria
• Avoid coming in contact with anyone who is ill with a contagious disease.