Patients with gastric cancer may experience decreased white blood cells and thrombocytopenia during chemotherapy, which are all considered adverse effects of chemotherapy – myelosuppression. What can be done to prevent and manage this common condition of myelosuppression?
Lowered white blood cells
The decrease in leukocytes during chemotherapy is primarily a decrease in neutrophils, which usually begins 1 week after chemotherapy is stopped, reaches a nadir at 10 to 14 days after stopping, remains low for 2 to 3 days, and returns to normal by day 21 to 28.
- Presentation Fever is sometimes the only reliable indication of neutrophil deficiency. In general, a single oral temperature measurement of no less than 38.3°C or no less than 38°C for more than 1 hour and a blood test of no more than 0.5 x 10/L neutrophils are defined as febrile neutropenia (FN).
- Harm Neutropenia may lead to infection of multiple tissues and organs, with the respiratory tract, skin mucosa, perianal, perineum, urethra, and various catheter or drainage sites being the more frequent sites of infection, as well as stomatitis, otitis media, bronchitis, and pneumonia. In severe cases, patients may also develop sepsis, where the infection causes a systemic reaction or even affects organ function, with a very high mortality rate if not treated promptly.
- Treatment Doctors will generally assess the risk factors for myelosuppression before chemotherapy and develop a reasonable regimen and dose. Granulocyte colony-stimulating factor (G-CSF) will be given as appropriate with chemotherapy, and some long-acting agents will be used if necessary. For patients with infections, G-CSF is usually given in addition to antibiotics and protective isolation and supportive therapy (oral feeding, nutritional support, oral care, antipyretic therapy, psychological support, etc.).
Thrombocytopenia
Thrombocytopenia occurs slightly later than neutropenia, usually dropping to its lowest value around 2 weeks of treatment, and its decline is rapid, with a short stay at the trough followed by a rapid rebound.
- Harm
- Harm A common manifestation of reduced platelets is a tendency to bleed, such as subcutaneous petechiae, bleeding gums, etc. In severe cases, there may be gastrointestinal bleeding and intracranial hemorrhage, which may be life-threatening.
- Treatment When thrombocytopenia is detected, doctors usually give platelet growth factor and platelet transfusions. Also, patients should be aware of the following.
- Reducing activity, preventing injury, and absolute bed rest if necessary;
- Avoid actions that increase abdominal pressure and pay attention to laxation and cough suppression;
- Reduce the chance of mucosal injury, eat soft food, prohibit nostril pulling, ear pulling, tooth brushing, etc., and replace tooth brushing with oral care;
- In case of nasal bleeding, you can usually stop the bleeding by pressing a clean towel against the nostril to stop the bleeding. If the bleeding is deeper in the nasal cavity, it needs to be treated by an otolaryngologist, possibly with nasal tamponade;
- When intracranial hemorrhage occurs, family members should watch to note changes in the patient’s mental, sensory, and motor changes as well as changes in respiratory rhythm, and inform the healthcare provider of any changes in a timely manner.
Anemia
- Manifestations There may be general feelings of dizziness, weakness, and sleepiness, with the most common and prominent manifestation being a pale complexion. In severe cases, patients may have varying degrees of respiratory, cardiovascular, digestive, and urinary system effects.
- Treatment Patients with anemia should rest, and be alert for sudden onset of hypotension (postural hypotension) when rising suddenly from lying down. If necessary, the doctor may recommend oxygen to raise the oxygen level in the blood. The doctor may also consider iron, erythropoietin (EPO) or even blood transfusions, depending on the circumstances. Patients should also eat more iron-rich foods.
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In conclusion, patients should be monitored, prevented, and receive standardized treatment under the guidance of their doctors for myelosuppression during chemotherapy. (Contributed by Cheng Yu, Department of Medical Oncology, The First Hospital of China Medical University)