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Chemotherapy: Blood Cell Counts (Bone Marrow Changes)

Bone Marrow

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© American Cancer Society 2010

The bone marrow is the thick liquid in the inner part of some bones that produces white blood cells (WBCs), red blood cells (RBCs), and blood platelets. One of the most common side effects of chemotherapy is damage to the bone marrow.

Cells are constantly produced and grow rapidly in the bone marrow. As a result, they are sensitive to the effects of chemotherapy. Until your bone marrow cells recover from chemotherapy damage, you may have abnormally low numbers of WBCs, RBCs, and/or platelets. This is called bone marrow suppression or myelosuppression.

While you are getting chemotherapy your blood will be tested regularly, even daily when necessary, so the numbers of these cells can be counted. This test is often called a complete blood count (CBC). If you are being treated for leukemia, bone marrow samples may also be taken periodically to check on the blood-forming marrow cells that develop into WBCs, RBCs, and platelets.

The decrease in blood cell counts does not occur right at the start of chemotherapy because the drugs do not destroy the cells already in the bloodstream (these are not dividing rapidly). Instead, the drugs affect new blood cells that are being made by the bone marrow.

As blood cells normally wear out, they are constantly replaced by the bone marrow. Following chemotherapy, as these cells wear out, they are not replaced as they would be normally, and the blood cell counts will begin to drop. The type and dose of the chemotherapy will influence how low the blood cell counts will drop and how long it will take for the drop to occur.

Each type of blood cell has a different life span:

  • WBCs come in several types that have a wide range of life spans. Neutrophils, a type of white blood cell of special importance in fighting infections live for an average of 6 hours
  • platelets average 10 days
  • RBCs average 120 days

The lowest count that blood cell levels fall to after chemotherapy is called the nadir. The nadir for each blood cell type will occur at different times, but usually WBCs and platelets will reach their nadir within 7 to 14 days. Because RBCs live longer, they will typically take several weeks to reach their nadir. Within 3 or 4 weeks after treatment, the blood counts improve and start to approach normal levels.


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