Bleeding and Bruising (Thrombocytopenia) and Cancer Treatment

Some cancer treatments, such as chemotherapy and targeted therapy, can increase your risk of bleeding and bruising. These treatments can lower the number of platelets in the blood. Platelets are the cells that help your blood to clot and stop bleeding. When your platelet count is low, you may bruise or bleed a lot or very easily and have tiny purple or red spots on your skin. This condition is called thrombocytopenia. It is important to tell your doctor or nurse if you notice any of these changes.

Call your doctor or nurse if you have more serious problems, such as:

• Bleeding that doesn’t stop after a few minutes; bleeding from your mouth, nose, or when you vomit; bleeding from your vagina when you are not having your period (menstruation); urine that is red or pink; stools that are black or bloody; or bleeding during your period that is heavier or lasts longer than normal.
• Head or vision changes such as bad headaches or changes in how well you see, or if you feel confused or very sleepy.

Ways to manage bleeding and bruising

Steps to take if you are at increased risk of bleeding and bruising:

• Avoid certain medicines. Many over-the-counter medicines contain aspirin or ibuprofen, which can increase your risk of bleeding. When in doubt, be sure to check the label. Get a list of medicines and products from your health care team that you should avoid taking. You may also be advised to limit or avoid alcohol if your platelet count is low.
• Take extra care to prevent bleeding. Brush your teeth gently, with a very soft toothbrush. Wear shoes, even when you are inside. Be extra careful when using sharp objects. Use an electric shaver, not a razor. Use lotion and a lip balm to prevent dry, chapped skin and lips. Tell your doctor or nurse if you are constipated or notice bleeding from your rectum.
• Care for bleeding or bruising. If you start to bleed, press down firmly on the area with a clean cloth. Keep pressing until the bleeding stops. If you bruise, put ice on the area.

Talking with your health care team about bleeding and bruising

Prepare for your visit by making a list of questions to ask. Consider adding these questions to your list:

• What steps can I take to prevent bleeding or bruising?
• How long should I wait for the bleeding to stop before I call you or go the emergency room?
• Do I need to limit or avoid things that could increase my risk of bleeding, such as alcohol or sexual activity?
• What medicines, vitamins, or herbs should I avoid? Could I get a list from you of medicines to avoid?