Low Platelets During Chemotherapy

This page is for people having chemotherapy whose platelet count is low or may drop.

Platelets help your blood clot. Chemotherapy and some other cancer treatments can lower your platelet count. Doctors call this thrombocytopenia. Low platelets make bruising and bleeding easier. The practical goal is simple. Know which bleeding signs your team wants to hear about. Know how often your counts get checked. Know whether any activities or medicines need a temporary change.

Platelets are made in your bone marrow. This is the same place that makes red and white blood cells. Chemotherapy targets fast-growing cells. That includes the cells that produce platelets. Platelet counts typically drop for a period after a chemotherapy dose. They then recover before your next cycle. Your care team checks your blood counts regularly. This tracks recovery and helps time your next dose safely.

Bruises that show up without a known bump are a common early sign. So are bruises that are larger than expected. Small red or purple pinpoint spots on the skin are called petechiae. These can appear on the legs or anywhere on the body. Nosebleeds that are hard to stop are worth reporting. So are bleeding gums when you have not brushed hard. Heavier or longer periods than usual are worth mentioning too.

Call your care team right away if you notice bleeding from your mouth, gums, nose, or rectum. Call for blood in your spit, vomit, urine, or stool; urine that is red or pink, or stools that are black. Call for more or worse bruises than usual, new small red or purple dots on the skin, or a period that is heavier or longer than normal. NCI says to call for bleeding that does not stop after a few minutes.

Call 911 or go to the emergency room if you fall or hit your head while your platelets are low, if you have bleeding that will not stop, or if you have new or worsening confusion. The American Cancer Society also says to get medical help immediately for a severe headache, blurred vision, or signs of a stroke. Do not wait to see if these symptoms settle on their own. Do not drive yourself.

During a low-platelet window, your team may ask you to use a soft toothbrush. They may ask you to shave with an electric razor instead of a blade. They may also ask you to avoid activities with a real fall or injury risk, like contact sports or ladder work. Small precautions matter more now, like being careful with kitchen knives or garden tools. This is temporary. It is tied to your cycle, not a permanent restriction.

The American Cancer Society advises avoiding blood-thinning medicines unless your doctor says you need them. This includes aspirin and NSAIDs such as ibuprofen and naproxen. Tell your care team about every supplement, vitamin, or herbal product you take. Some of these can affect your blood too. Check with your care team before starting or stopping anything during treatment. This applies even to things you have taken for years without a problem.

Your care team may delay treatment if your platelet count is too low on the day your next dose is due. They may also adjust your dose. The American Cancer Society notes that a platelet transfusion might be needed if your platelets are very low, or if you already have signs of bleeding. These decisions depend on your exact count, your symptoms, and your specific treatment plan.

• How low are my platelets, and are they expected to recover before my next cycle?
• Which bleeding symptoms should make me call right away?
• Are there medicines, supplements, dental work, or activities I should check with you about first?
• Could my dose or schedule change if my platelets stay low?

• National Cancer Institute — Bleeding and Bruising (Thrombocytopenia) in Cancer Treatment
• American Cancer Society — Low Platelet Count (Thrombocytopenia)