Treatment Was Delayed by Low Blood Counts

This page is for people whose chemotherapy was delayed because of low blood counts. It explains why that happens and how to stay safe while counts recover.

Chemotherapy damages fast-dividing cells. That includes the cells in bone marrow that make blood. Counts are checked before each cycle because the marrow has to recover enough to handle the next dose. Counts fall to their lowest point, called the nadir, usually in the week or two after a dose. They then climb back before the next cycle is due.

Three numbers usually drive the decision:

• Neutrophils are the white cells that fight bacterial infection, and the absolute neutrophil count is what sets infection risk.
• Hemoglobin reflects red cells and how well your blood carries oxygen.
• Platelets control clotting.

Hearing that treatment is postponed can feel as though something has gone wrong. What has actually happened is that the plan is working as designed. When counts are low, the team has standard options. The dose might be lowered, the treatment might be switched, or treatment might be held until your body recovers. Rest periods between cycles exist so the marrow can rebuild.

Delays of a week are routine. It is still reasonable to ask what the number was, and how long the pause should last. Ask whether the total number of cycles changes, and what has to be true before treatment restarts.

Your team may add a growth factor to help the marrow make white cells faster. This drug is called a granulocyte colony-stimulating factor (G-CSF). It is given as an injection, often the day after chemotherapy. Some come as a device that delivers the dose automatically later.

Deep aching in the lower back, hips, breastbone and long bones is the effect people report most often. It usually starts a day or two afterward. Ask what you may take for it, since the answer depends on your other medicines.

Low red cells or platelets may be managed with a transfusion rather than a growth factor.

Basic precautions matter most in the week or two after a dose. Wash hands often and thoroughly. Keep any central line site clean and dry. Follow food safety advice. Avoid people who are unwell, and be careful in crowded indoor spaces. Ask your team about dental work, vaccinations and travel during this window rather than assuming.

If your platelets are low, use a soft toothbrush and an electric razor rather than a blade. Avoid contact sports and anti-inflammatory painkillers unless your team has cleared them.

The guidance is direct: CDC says a temperature of 100.4 degrees Fahrenheit (38°C) or higher during chemotherapy is a medical emergency, and to call your doctor immediately, day or night. NCI's own page prints 100.5°F for the same temperature, a rounding difference; 100.4°F is the figure CDC and most cancer centers use. Infections during cancer treatment can be life threatening and need urgent medical attention. Do not take acetaminophen or ibuprofen first to see whether the fever settles. Those medicines can lower a temperature and hide a more serious problem. Ask for your team's exact threshold and the after-hours number, and keep both written somewhere you can find them at 3am.

• Go to an emergency department if you measure a fever at or above your team's threshold and cannot reach them within minutes. A fever while your neutrophils are low is an emergency in its own right, not a wait-and-see call, and it needs antibiotics within about an hour of arrival. Go straight away if fever comes with confusion, faintness or laboured breathing. Do not drive yourself.
• Call 911 or go to an emergency department if platelets are low and a nosebleed will not stop with 15 minutes of firm pressure (MedlinePlus gives 20 minutes for the general public; do not wait that long with low platelets), you have black, tarry stools, blood in your vomit or stool, or you vomit material that looks like coffee grounds, you have new chest pain or tightness, or you have any head injury, even a minor one (MedlinePlus: nosebleed; MedlinePlus: GI bleeding). Do not drive yourself.
• Call your care team right away, at any hour, if shaking chills arrive even without a measured fever, or you develop a new cough, breathlessness, burning on passing urine, diarrhea, a new rash, mouth sores that stop you eating, or redness or pain around a line site or wound. A normal temperature is not a reason to wait (CDC).
• Call your care team right away if platelets are low and you have bleeding gums, blood in your urine, or bruises and tiny red skin spots that appear without explanation. Get checked after any fall rather than waiting it out.
• Call your care team within a day or two if mild activity leaves you breathless, or you feel dizzy or look unusually pale.

• NCI - Infection and Neutropenia During Cancer Treatment
• NCI - Chemotherapy to Treat Cancer