Blood cells are produced by the bone marrow, a spongy material contained within the bones. This cell factory pro duces red and white cells, and platelets. Chemotherapy treatment can cause bone marrow depression, which results in significant depletion of cells cir culating throughout the bloodstream. Blood tests will be carried out regularly during treatment to monitor the number of blood cells (blood count), and ensure your child’s bone marrow is not being too badly impacted by his drugs. If your child’s blood counts drop, the doctor will either reduce the dose of his drugs or increase his rest period between treatments. Although this is worrying and frustrating, it is a common occurrence, and should not cause a major disruption to his protocol. Delaying treatment by a week or so is much safer than giving drugs whilst your child's counts are depressed. An increased rest period will allow counts to recover before treatment resumes. Red blood cells - which carry oxygen to throughout the body. White blood cells - which help you to fight infection. Platelets - which help the blood to clot, preventing bruising and bleeding. These three blood cell types are counted during a Complete or Full Blood Count (CBC/FBC). Though many parents do not notice any unusual changes, your child may feel tired and display a depressed mood when his count is at its lowest. This typically occurs 10 14 days following treatment. However, if your child’s count drops significantly, you may see a number of symptoms which should be reported to the doctor as soon as possible. Low red cell counts may cause your child to become anaemic, feel fatigued or short of breath. A transfusion may be needed to increase the number of red cells in the blood If your child's white cell count decreases, he will be more susceptible to infections. Contact his doctor if he develops a sore throat or starts running a temperature of 38.5oC (101oF) or above, or if he displays any other symptoms suggestive of infection, such as rash or burning sensation when passing urine. The doctors might prescribe a maintenance antibiotic like Bactrim while his immune system is compromised. Ask if this will be the case. Low platelets mean your child may bruise more easily. You may notice that his gums bleed when brushing his teeth, or he may have nosebleeds. A transfusion may be needed to increase the number of platelets in the blood Drugs called colony stimulating factors may be given to help stimulate your child's production of blood cells. These drugs may be given immediately after treatment over a period of days to reduce the likelihood of the symptoms outlined above. Anything unusual for your child should be reported to his doctor immediately, even though it may seem trivial. Prompt treatment of bone marrow depression is essential to protect your child. Strict policies regulate the use of donor blood. All donations are screened for the HIV virus, which causes AIDS, and people in known high risk groups are discouraged from becoming donors. An additional process heat treats blood products to destroy any unidentified virus. The risks of transferring HIV disease through transfusion are extremely small. When chemotherapy begins, you will quickly come to realise that the white count of your child on treatment has a massive influence on your family’s daily activities. The Absolute Neutrophil Count (ANC), sometimes called Absolute Granulocyte Count, (AGC), provides an overall indication of your child's infection fighting capabilities. Click here to learn more about the ANC. An ANC over 1000 is considered sufficient provision of protective neutro phils your child requires to fight off exposure to bacterial or fungal infection. When his ANC is this high, you can allow your child to participate in all regular activities such as school, sports, and socialising. However, closely monitoring the pattern of your child's ANC is advisable at all times. For example, if your child’s ANC is 1000, but you know that his pattern suggests it is likely to decrease imminently, your decisions about his activi ties are likely to differ. Your child’s hospital will provide you with its own guidelines relating to appro priate activities for children with a low ANC. Frequent, thorough hand washing is a must to prevent the spread of infection. Use a soap dispenser rather than a bar. Lather well with warm water, ensuring that all portions of the hands and lower arms are well scrubbed. Insist that every member of the family, and all visitors, follow this practice, and explain the importance of this action, to avoid misunderstandings. Both children and adults should always wash hands before preparing meals and before eating, after working or playing outside, and after using the bathroom. Whilst on the move, carry a pack of baby wipes for cleaning hands. Keep your child's nappy/diaper area and skin creases clean and dry. Consider using disposable nappy brands during treatment. If possible, make arrangements with your child’s doctor to use a back entrance at the surgery to avoid exposure to potential germs in the waiting room. Making early morning appointments will mean that your child is more likely to be seen in a room that has not yet been exposed to many infectious germs.. Ensure your child's skin is thoroughly cleaned with both betadine and alcohol before all needle sticks. Ensure that all medical staff and visitors at the hospital or doctor's surgery wash their hands before touching your child. If Neutropenic guidelines are posted on the door of your child’s hospital room, or beside his bed, consider posting up your own “user friendly” guidelines, and involve older children in designing them. Keep your child away from school, and restrict the number of visitors he receives. Consider asking the school to send a letter to parents which outlines the need for your child to be protected from illness, and request that they notify the school if their child is a little unwell, but intending to attend school. Limit your child’s outings to crowded places such as shops, cinema, public swimming pool, church or public transport. These will exposes him to many potential germs. Wash any small cuts or grazes with soap and water, then rinse with hydrogen peroxide, and cover with a clean plaster/band aid. Take your child's temperature daily, and at the same time. When he is unwell, take his temperature every two to three hours. Keep a record of all readings so that you can make comparisons. Do not take a rectal temperature (in the anus) or use rectal suppositories. This could cause anal tears which increase the risk of infection and bleeding. Do not use a humidifier because the stagnant water may become a reservoir for contamination, increasing your child‘s risk of exposure to germs.. Always apply sunscreen when your child goes outside on warm days. Children taking certain chemotherapy drugs are sun sensitive, and sunburn becomes a potential site for infection. Your child must not receive vaccinations during chemotherapy treatment. Ensure that siblings are not vaccinated with live polio virus (OPV). Ask for the killed polio virus (IPV), and verify that the paediatrician or nurse is using the correct vaccine. Be aware that if your child's ANC is low, an infected site may not exhibit the usual signs of redness or pain. Never try to treat fever with aspirin, Motrin, or ibuprofen as they may interfere with your child’s ability to clot blood. if he has a fever, consult his doctor before administering any medication. If constipation is a problem for your child, ask his doctor about the usefulness of a stool softener as these can help prevent anal tears which may lead to infection.. Chicken pox and pneumonia plague children whose immune systems are depressed during cancer treatment, and they can be potentially very serious infections. Pneumonia Primarily caused by bacterial or viral infection, pneumonia is an inflammation of the lungs, causing such symptoms as chills, fever, sore throat, rapid breathing, chest pain, cough, and bloody sputum. Low blood counts mean that a child’s condition may quickly become fatal, so prompt and aggressive treatment is paramount. Contact your child’s doctor immediately if he displays any of the symptoms outlined above. Chicken pox A common childhood disease, chicken pox is caused by the vari cella zoster virus. Initial symptoms include fever, headache, and general malaise, followed by the eruption of pimple like red bumps, typically beginning on the torso (stomach, chest, or back). These develop into blister like sores which break open and scab over within three to five days. .Patients are contagious for up to 48 hours after onset of the sores, and the virus can be transmitted through physical contact or by breathing in contaminated air. This means that any contact with an affected individual presents a risk for spread of the disease. Left untreated, chicken pox may result in the life threatening complications of pneumonia, encephalitis and hepatitis. For immunosuppressed children, the disease can become fatal very quickly, so it is especially important that you take every precaution to prevent exposure during your child’s cancer treatment, and maintain a heightened vigilance for signs of the disease. Chicken pox exposure occurs if a child comes into direct contact with an affected patient, or stays in a presumably contaminated room for ten minutes or more. Call your child’s doctor immediately following suspected exposure. Administration of the Varicella Zoster Immune Globin (ZVIG) injection within 72 hours of exposure may prevent onset of the disease or minimise its effects. If your child does develop chicken pox during chemotherapy, he will most likely be given the standard treatment of intravenous acyclovir, a powerful antiviral medication which has dramatically lowered the occurrence of associated complications. Oncologists and institutions have varying opinions regarding hospitalisation or home care during treatment, and you should discuss the best option for your child.. Scientists have developed a chicken pox vaccine. It is hoped this will be used for children with cancer in the future, but there is currently insufficient data to indicate its safety or value in this group of patients. Shingles (herpes zoster) is a potential risk for your child during cancer treatment if he has already had chicken pox. In this case, small pimples similar to chicken pox will develop in lines along the nerves. If this happens, call the doctor immediately. Treatment is identical to that for chicken pox. Educating your child’s teachers and friends’ parents on the need to be vigilant for, and report, any signs of outbreak will enable you to ensure he avoids exposure as much as possible. For example, if the nursery or school notifies you of any chicken pox cases, you can make arrangements to keep him home from class until you are sure the outbreak is over. Call your child’s doctor if he exhibits any of the following symptoms. fever above 38.5oC (101oF), chills, cough, sore throat, Rash shortness of breath, severe diarrhoea, bloody urine or stool, pain or burning while urinating. Anything that is out of the ordinary for your child and causes you concern. House hold pets are unlikely to present a threat to your child during treatment, but you should use common sense to protect him from disease, worms, or infection when his ANC is low. If you have siblings, it will be helpful to encourage all the children to follow the precautions outlined below, as this will avoid resentment which can arise from the act of singling out one child, and will also lower the risk of potential infection. Ensure each of your pets is up-to-date with all vaccinations, and have them checked regularly for worms and fleas once your child has been diagnosed. Puppies and kittens are more vulnerable to these pests, so take special care if you have any. Keep special plates, bowls and serving cutlery for your pet, and do not allow them to eat off your own plates, or lick your child's face. Keep children away from the cat’s litter tray and any animal faeces out side. Keep sponges, gloves and drying cloths for the exclusive cleaning of litter trays, and ensure they are regularly washed and changed to prevent potential sources of infection. Ensure children thoroughly wash their hands after playing with the pet, and wash your dog if he comes into contact with copious amounts of water or mud. Keep a special wash cloth and towel handy to clean the dog’s feet before he comes indoors. Consider finding another home for your pet if he has a tendency to bite or scratch. Though this may be a very hard decision, the animal may be a potential infection risk for your child. However, if your pet is gentle and well loved, do not give him away without very good reason. Research has shown that pets can be highly therapeutic, and a well chosen pet will be a huge source of comfort for you and your child during the course of the cancer and its treatment. However, there are some things you should bare in mind when making your choice. Puppies may look very cute and inviting, and be the dream of many a child. However, they are not a good option as all breeds and mongrels bite whilst teething. This increases the possibility of your child’s exposure to infection. Do not get a parrot or parakeet as these birds can transmit the psittacosis infection. Do not get any reptiles, including turtles, snakes and iguanas, as they may present a risk of salmonella infection. Try to avoid choosing any animal likely to bite or scratch. A good knowledge of the animal’s physical and behavioural history may help you in this respect. Wherever possible, have the animal examined by a vet before you agree to take it home. Tell the vet that your child has cancer, and ask for a thorough examination. Always ask your child’s oncologist for advice about any animals you already own or are thinking of getting.. Go back to CHEMOTHERAPY SIDE EFFECTS page. Go back to GENERAL TREATMENT index. Go back to ORbIT TREATMENT index. Go back to SONGS TREATMENT index. |
| "Do not go where the path may lead, go instead where there is no path - and leave a trail." ~ Ralph Waldo Emerson ~ |
| SIDE EFFECTS OF CHEMOTHERAPY Low Blood Counts |
| ORPHANS OF THE CANCER STORM |
| Disclaimer This information page has been prepared by an individual who does not have medical training. However its contents have been reviewed by appropriately qualified medical professionals for accuracy and quality. This page is intended for information purposes only and should not be used as a guide to diagnosis or treatment. If this information raises any concerns about your child’s condition or care protocol, discuss them with his or her paediatrician, oncologist, or other appropriate medical professional who has knowledge of the case. |
| I've been told that my child will have regular blood tests once he has started treatment. Why is this necessary? |