A low platelet count is a common side effect of chemotherapy. If your platelet counts drops too low, your doctor may reduce, delay, or discontinue chemotherapy treatment.
Platelets are special blood cells that help your blood clot. A low platelet count is medically known as thrombocytopenia.
If you have thrombocytopenia, you may have symptoms such as:
- prolonged bleeding from small cuts
- easy bruising
- frequent nosebleeds or gum bleeding
- heavy menstrual bleeding
You can develop thrombocytopenia for many reasons, including undergoing chemotherapy. When chemotherapy is the underlying cause, it’s called chemotherapy-induced thrombocytopenia.
A normal platelet count is usually considered between
This article will look at how chemotherapy affects your platelet count and how chemotherapy-induced thrombocytopenia is treated.
Chemotherapy (also referred to as chemo) drugs contain chemicals that destroy cancer cells or slow down their growth. These chemicals act broadly on all cells in your body that replicate quickly. The cells in your bone marrow that create platelets are particularly prone to damage from chemo.
A reduced platelet count is a common chemotherapy side effect. In a recent
Chemotherapy-induced thrombocytopenia is
| Grade | Platelet count (billions per liter) |
|---|---|
| Grade 1 | 75–100 |
| Grade 2 | 50–75 |
| Grade 3 | 25–50 |
| Grade 4 | less than 25 |
Chemotherapy regimens and platelet count
Many types of chemo drugs are used to treat cancer, and doctors often administer multiple drugs at the same time to target cancer cells in different ways.
Some drugs or combinations of drugs come with a higher risk of damaging your platelets than others.
In a 2020 study, researchers examined the rates of thrombocytopenia among 523 people undergoing treatment for a type of non-Hodgkin’s lymphoma called diffuse large B-cell lymphoma.
They reported the following rates:
| Regimen name | Drugs included | Percentage of people who developed thrombocytopenia |
|---|---|---|
| ACVBP | • cyclophosphamide • doxorubicin • vincristine • bleomycin • prednisone | 44.4% |
| CHOP | • cyclophosphamide • doxorubicin hydrochloride (Adriamycin) • vinblastine • prednisone | 25.2% |
| DHAP | • dexamethasone • high-dose cytarabine • cisplatin | 92.3% |
| EPOCH | • cyclophosphamide • etoposide • doxorubicin • vinblastine • prednisone | 39.0% |
| GDP | • gemcitabine • dexamethasone • cisplatin | 69.4% |
| GEMOX | • gemcitabine hydrochloride • oxaliplatin | 69.0% |
| ICE | • ifosfamide • carboplatin • etoposide | 89.7% |
If you develop thrombocytopenia, future doses of chemotherapy may be:
- reduced
- delayed
- discontinued
There’s no universally agreed-on minimum platelet count for when doctors decide to delay or discontinue chemotherapy. Your doctor will use their best judgment based on your symptoms and the results of your blood tests to decide when you may be able to resume treatment.
Your doctor may want to administer chemo and radiation therapy with caution at platelet levels under
You usually wouldn’t have bleeding complications or need platelet transfusion unless your platelet count drops under
Symptoms are often worse 10–14 days after receiving your first session of chemotherapy.
You may need a platelet transfusion if your platelet count drops severely low or if you have bleeding complications.
A platelet transfusion involves injecting platelets from donors into your blood. Unlike red blood cells, platelets don’t have blood types so you can receive platelets from almost anybody. Often platelets in transfusions come from
When do doctors recommend platelet transfusions?
Doctors usually only recommend platelet transfusions if your platelet count drops severely low or if you’re having reoccurring bleeding complications.
Some chemo regimens are more likely to drop your platelet low enough for you to require a platelet transfusion than others. Here are some examples of low platelet rates based on different cancer
| Regimen | Cancer | Rate |
|---|---|---|
| ibritumomab tiuxetan | non-Hodgkin’s lymphoma | 30% |
| ICE | non-Hodgkin’s lymphoma | 23% |
| gemcitabine and cisplatin | unknown originating location | 15% |
| gemcitabine and cisplatin | non-small cell lung cancer | 9% |
| topotecan | small cell lung cancer | 5.8% |
Medications for low platelet count
Drugs called antifibrinolytic agents are currently being tested for treatment of thrombocytopenia, but the results and benefits
Supporting treatment
Treating other causes of thrombocytopenia may help raise your platelet count. Treatment might consist of:
- stopping certain antibiotics
- treating underlying infections
- controlling genetic diseases linked to problems with blood clotting
- making dietary improvements
Taking steps to avoid bleeding or bruising may help reduce thrombocytopenia complications. Steps you can take include:
- flossing your teeth gently
- using a soft bristle toothbrush
- using moisturizers and lip balm to prevent skin dryness or cracking
- avoiding activities with a high risk of injury, such as contact sports
- taking care when using knives, razors, or sharp objects
- wearing shoes and socks to protect your feet
- removing clutter on the floor to reduce the risk of tripping or falling
Chemicals in chemotherapy drugs can damage healthy cells in your body that replicate quickly. The cells in your bone marrow that produce platelets are particularly vulnerable to damage from chemo.
A low platelet count is a common side effect of chemo. Platelet counts often return to normal within 4–6 days. If your platelet count drops too low, your doctor may reduce, delay, or discontinue chemo treatment.