New blood cells are constantly being made in the bone marrow. The bone marrow is the softer inside of long bones like you have in your arms and legs. When you receive chemotherapy, some of these developing blood cells may be destroyed. This can change the blood that is circulating throughout your body and have a variety of different effects. Most of these effects will begin 7-14 days after you get your chemotherapy, but you will need to check with your nurse or doctor to see exactly when your chemotherapy might cause these problems.

One change in the blood is called anemia. This is a decrease in the number of circulating red blood cells. Red blood cells carry oxygen to all parts of your body. When you don’t have enough circulating red blood cells, you may become easily tired or feel short of breath, especially when you are up and moving. You may feel that your heart is beating more quickly than usual, as it tries to move more oxygen around the body. You make appear pale or tired, become cold easily, or be depressed or sluggish.

Make sure that you report these problems to your nurse or doctor. You may need to have blood drawn to see if your red blood cell count is low. In some cases, your chemotherapy treatment may need to be postponed until your red blood cell count is more normal. There are medications that can help to stimulate the growth of the red blood cells when necessary. In some cases you may need to receive a blood transfusion.

There are several things you can do to help prevent or control anemia during chemotherapy. First, make sure you are eating a well-balanced diet that includes iron. Iron helps to build the red blood cells. Second, make sure you rest when you are tired and remain active when you can. Exercise is important to keep your body in good shape, but rest helps the body to rebuild. A good balance of exercise and rest can also be a good way of reducing stress.

Another change in your blood that can happen with chemotherapy is a decrease in the number of platelets. Platelets are the part of the blood that helps with clotting. When you don’t have enough platelets, you may bruise or bleed more easily from small bumps. You may find that when you do get a small cut, you have trouble stopping the bleeding. Your mouth may bleed when you brush your teeth. You may have a nosebleed.

Make sure that you talk with your doctor or nurse if you experience any of these problems. It may be necessary to have blood drawn to check your platelet count. There are medications that can boost your body’s ability to make new platelets so that clotting will improve. In some cases, you can be given a transfusion of platelets.

To help prevent the problems associated with a low platelet count, there are several things that you can do. First, be especially careful about bumps or bruises until your counts improve. You may want to avoid contact sports and vigorous activity. Make sure that you wear shoes to prevent injury to your feet. When working with your hands, gloves may be appropriate to prevent scratches and skin irritation. Make sure you are doing thorough but gentle mouth care. A softer toothbrush than usual or a toothette (a tiny sponge on a stick) may be better for brushing your teeth until your platelet count improves. Avoid the use of tampons and suppositories. Sexual intercourse may need to be postponed until your platelet count improves. If you are sexually active, make sure you use adequate lubrication to avoid irritation during sex.

Perhaps the most important change that can occur in the blood during chemotherapy is the decrease in your white blood cell count. The white blood cells help to prevent infection throughout the body. This means that it will be easier for you to get infections. Make sure to let your doctor or nurse know if you think you may have an infection. Things to look for include a cough or cold, difficulty breathing, sinus problems, a headache that won’t go away, any rashes or skin problems, sores in your mouth, any new or unexplained pain, a fever (temperature more than 101 degrees) or problems with your urine like burning or frequent urination. Besides treating you for infection, your healthcare provider may want to draw blood to check your white count. In some cases, you can be given medications to boost your immunity and help prevent infections.

What can you do to prevent infection problems while your white count is low? One of the most important thing you can do is good handwashing. After handling anything in public (money is a good example), after using the bathroom, and especially before you eat or drink, make sure you wash your hands thoroughly with plenty of soap and running water. This will wash away germs that may be on your hands and cause infection. It is also important that people coming to see you while your white count is low wash their hands well.

You should avoid people with coughs, colds or any infections. You need to be careful to avoid children who may have been exposed to mumps, measles, chickenpox or other childhood diseases as well as children who have been vaccinated using live vaccines. Your doctor or nurse will talk with you about this if it is a concern.

If you get a cut or scrape, wash it carefully but thoroughly with soap and water, and apply an antibacterial ointment and a bandaid. This will help to protect the area until it heals. If it does not heal quickly let your doctor or nurse know.

Another important thing to do to prevent infection is to do thorough but gentle oral care. The mouth carries many germs that can become a problem during chemotherapy. Make sure to brush your teeth each time after you eat. A saline (salt water) rinse may also be helpful. Full strength mouthwash may be irritating to the mouth during this time. If you want to use mouthwash, it is a good idea to dilute it, using half water and half mouthwash to rinse.

The germs found on flowers, fresh fruits and vegetables, and your family pet can be a problem when your white count is particularly low. You need to avoid handling or eating fresh fruits and vegetables as well as pepper during this time. Handling fresh flowers or having them in your house or hospital room can also spread these germs. If you have a family pet, continue to enjoy it, but let someone else empty litter boxes, change bedding, and groom your pet. It is important to remember that your white count will only be very low for a short period of time. Then you can enjoy these things again.