Bruises and bleeding in cancer patients

Cancer and cancer treatment may cause many different side effects, including bruising and bleeding.

What is thrombocytopenia or low platelet count?

Thrombocytopenia is a condition that occurs when low levels of blood cells called platelets are present. These cells assist with blood clotting to stop bleeding. If a patient has a low platelet count, it’s easier for him or her to bruise or bleed. The patient also may have small red or purple spots on his or her skin.

Why are bruises and bleeding side effects of cancer and cancer treatment?

People with cancer may experience thrombocytopenia, or more bruising and bleeding. Below are some of the possible reasons for this.

Antibodies: Antibodies help to kill pathogens such as bacteria and viruses, but they sometimes kill healthy platelets.

Chemotherapy: This type of therapy may damage bone marrow, or the tissue in the bones where platelets are made.

Specific types of cancer: Leukemia and lymphoma may decrease a patient's platelet count. Also, cancer that has spread to the bone may lead to thrombocytopenia because the cancer cells may make it hard for bone marrow to produce more platelets. Cancer in the spleen may lead to bleeding issues because the spleen typically stores extra platelets. Cancer may make the spleen bigger, causing it to hold on to those platelets instead of circulating them elsewhere in the body.

Radiation therapy: Although radiation therapy doesn’t typically lead to a low amount of platelets, a patient's platelet levels may decrease if he or she is also receiving chemotherapy, or is getting a large amount of radiation therapy to the pelvic area.

Surgical site bruising and bleeding: If a patient has had surgery for cancer, it’s not uncommon to notice bruising near the surgical site or the leakage of some blood. This isn’t necessarily thrombocytopenia. Follow any instructions received on caring for a surgical site wound. If it’s bleeding a lot, let the surgeon know or seek immediate medical care.

Thrombocytopenia symptoms

Symptoms of thrombocytopenia may include:

• Bleeding from areas such as the mouth, nose or rectum
• Bloody spit or vomit
• Bruises on the skin that come from unknown causes
• Heavy vaginal bleeding during menstrual periods
• Joint or muscle pain
• Purple or red dots on the skin
• Urine that has a brown, pink or red color
• Stools that have blood in them, making them look bright or dark red, or even black
• Weakness
• Severe headaches
• Vision changes

Let the care team know if any of these symptoms occur.

Treating thrombocytopenia or low platelet count

Some treatments are available for patients with thrombocytopenia.

If surgery is recommended but the patient's platelet count is low, he or she may need to wait until platelet counts become higher. This will help cut the risk of heavy bleeding.

If low platelets are due to chemotherapy, the care team may change the treatment. This may include a lowered chemotherapy dose or adding more time between treatments. A drug called oprelvekin may be used to help prevent low platelet count.

If the patient has a very low platelet count, the care team may order a transfusion of platelet cells. This is when the patient receives donor platelets through a blood infusion. The effects from transfusions usually last about three days. Transfusions may help treat or prevent heavy bleeding, but may pose potential risks. These include:

• Transfusion reaction, which may look like an allergic reaction
• Transfusion-related lung injury, which may cause breathing problems
• Exposure to human immunodeficiency virus (HIV), hepatitis B or hepatitis C

Ask the care team about the benefits and risks of a transfusion.

How to prevent bruising and bleeding

If a patient has thrombocytopenia, he or she should take certain steps to lower the risk for bleeding and bruising.

1. Avoid physical activity that could lead to an injury, including contact sports.
2. Protect the skin against scrapes and sharp objects.
3. Use a soft toothbrush. A hard toothbrush may irritate the gums.
4. Find out from a dentist or the care team if it’s OK to floss.
5. When shaving, use an electric razor,
6. Nose blowing should be done gently.
7. Avoid straining during a bowel movement. Using a stool softener may help with this. Patients who get constipated should let the care team know.
8. Avoid putting anything in the rectum, such as enemas or suppositories.
9. If a nosebleed occurs, the patient should sit up with his or her head tilted forward. He or she may place ice on the nose and pinch the nostrils shut for five minutes to help reduce bleeding.
10. Use a washcloth or paper towel to press on any areas of bleeding.
11. Wear shoes even inside the home to reduce the chance of a cut or scrape on one of the feet.
12. Ask the care team about any medications to avoid that may increase the risk for bleeding. This may include medicines with aspirin or ibuprofen.
13. Use sharp objects—such as a knife, a needle or scissors—with extra care.
14. Seek urgent medical attention if the patient is bleeding a lot more than usual or if he or she has trouble stopping the bleeding.