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Thread: Low blood counts/transfusions during chemo?

  1. #1
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    Low blood counts/transfusions during chemo?

    My partner E has Stage IV NSCLC. He has had 2 rounds of carboplatin and gemcitabine, in 3 week cycles. Each time, round about the beginning of week 3, his nose bled for days and he was admitted to hospital with platelet counts of 12 the first time and 11 the second time. He had platelet transfusions and red blood cells too. He felt dreadful, but better after the transfusions. On top of this, his right lung progressively filled with fluid, and he spent last week in hospital again where they drained almost 5L of fluid from the pleural lining. He now has a small amount of air left in the space but is feeling great. He was due to have a review scan at the time he was in hospital, but because of the fluid they couldn't see anything. They did the scan again after the fluid was removed, and we've been told verbally that it's pretty similar to the scan he had before starting chemo. This seems fairly positive news to me, the cancer hasn't spread or progressed. He has also been taking dexamethasone, antibiotics and sickness tablets.

    My question is, has anyone else had the chemo attack their platelet counts and red blood cell counts to this extent? Were you able to carry on with the chemo? We're due to see the consultant on Monday to discuss what to do next and I'm wondering what they mght suggest. During the chemo, E was tired, confused, aching and found it very hard to eat. He has lost around 28 pounds in weight, his legs are very weak and he can hardly walk. During this little chemo holiday just now, he's feeling much better, eating four times a day and exercising to build up his strength ready for what comes next. If the chemo is working, we want to carry on because it's only a few weeks and we know he'll feel better at the end, but can they manage these blood counts?

    Thanks folks, hope I haven't forgotten anything, RBx
    57 year old partner diagnosed in November 09 with Stage IV NSC adenocarcinoma lung cancer. Two rounds of chemotherapy gave very little change. Problems with very low levels of platelets and no further chemo proposed due to his extreme weight loss (over 40lbs). Had 5 sessions of radiotherapy to lung. Sadly passed away in a beautiful hospice March 2010.

    Can't bear to be without you my love, but will try my best to keep going.

  2. #2
    Administrator Top User pbj11's Avatar
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    Hi Ruthie,

    Chemo can affect people in many different ways. The blood counts usually take a beating. Are they giving him blood enhancers after chemo, like Procrit for red blood count/hemoglobin and Neulasta or Neupogen for his white blood count? They typically do blood work on a regular basis to carefully monitor which direction the counts are going so they know if these enhancers are necessary. Blood transfusions aren't uncommon either. Haven't seen too many people complain about platelet counts, but they definitely are a component of the blood. Years ago my mother had many platelet infusions during her chemo.

    I'm sorry to hear he had pleural effusion problems. I wondered about that when your description included some pain in his back and him being breathless. Five liters is a huge amount to drain. He needs to stay on top of what he's feeling and report anything like this to the doc before it gets that large again. Hopefully the effusion issues will resolve when the chemo starts shrinking the tumor.

    Typically they will feel bad for a portion of the time between cycles and start to feel pretty good before the next cycle begins. If the chemo is working well, his weight should begin trending upward. He needs to eat steadily to maintain his strength and put the weight back on, in addition to helping his blood counts.

    Good luck and keep us posted on his progress. It's a bumpy ride.

    God bless,
    PBJ
    Husband diagnosed with NSCLC Stage IV in 3/2005. Fought & lived over 2 1/2 years with multiple lines of treatment.

    Post describing our journey: http://cancerforums.net/viewtopic.ph...er=asc&start=0

    Left my embrace to live with our Heavenly Father in October of 2007 and now breathes with ease forever. I will miss this gentle, giving soul with the easy smile for the rest of my days, but have faith we will be together again. He's just getting a little break from me!

  3. #3
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    Thanks pbj, that's good info. He hasn't had any blood enhancers so far, they didn't really do anything each time until his nose had been bleeding for a couple of days. The lack of platelets reduced his clotting ability. Hopefully they'll come up with something more pro-active for the next cycles! I'm glad to hear that others have been given platelets before.

    We did have an idea that there was fluid in that lung, and every time we went for chemo or any appointment we told them that E was having great trouble with his breathing. The fact he had to get a wheelchair to get into the hospital each time was a clue for them too! But while he was managing to get about, they just left it until the scan showed the extent of the fluid. He had the scan as an outpatient, and it was actually the staff at the CT scan who said they couldn't let him go home because he was so breathless. It had been obvious to us for weeks! But then everybody was very helpful and they got the chest drain in that day. I think there's a problem here of the left hand not speaking to the right hand and only dealing with the immediate issue not the whole picture! If someone was giving him chemo, they weren't worried about the breathing. They all just waited for the scan to show them what was going on. We'll be a bit more demanding in future if he starts getting that uncomfortable with his breathing again.

    E never really felt good between cycles, but I suppose the fluid was partly responsible. At the end of the cycles was when they gave him the red blood cells and that helped a lot, I think he really needed that oxygen!

    Onward and upward - I'll update my status after we see the consultant and let you know how it goes.
    RBx
    57 year old partner diagnosed in November 09 with Stage IV NSC adenocarcinoma lung cancer. Two rounds of chemotherapy gave very little change. Problems with very low levels of platelets and no further chemo proposed due to his extreme weight loss (over 40lbs). Had 5 sessions of radiotherapy to lung. Sadly passed away in a beautiful hospice March 2010.

    Can't bear to be without you my love, but will try my best to keep going.

  4. #4
    Administrator Top User pbj11's Avatar
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    Ruthie,

    Oops -- forgot to mention that my husband experienced bloody noses too. His didn't go on for long periods of time, but did seem to be a side effect of the chemo. (He had a genetic clotting condition, quite the opposite of your husband's issues with the low platelets, yet he still had the darn bloody nose thing going on.)

    They need to be listening to his chest on every visit to the doc or when he gets his blood work done by the nurse. Our doc required bloodwork at least once a week to closely monitor what his counts were doing. Why are they not giving him any enhancers? These should be done to try and prevent the transfusions. (I don't think there is anything for the platelets though.)

    My husband was also under the care of a pulmonologist. She told us that his lungs sounded deceptively good, even when he'd be having effusion. He had so many thoracenthesis done that she depended on us to let her know when it was time to drain him again. (He refused permanent drains or a pleurodesis procedure.)

    This is where you become the advocate for his well being by getting on the phone and making sure all the bases are covered. They feel bad enough without the breathing issues. Five liters!!!!! I can't begin to imagine how bad he must have been. I think 2 or 3 liters was the most they drained from my husband at one time. I should have mentioned it when I saw the classic effusion symptoms in your tagline. I'm sorry.

    God bless,
    PBJ
    Husband diagnosed with NSCLC Stage IV in 3/2005. Fought & lived over 2 1/2 years with multiple lines of treatment.

    Post describing our journey: http://cancerforums.net/viewtopic.ph...er=asc&start=0

    Left my embrace to live with our Heavenly Father in October of 2007 and now breathes with ease forever. I will miss this gentle, giving soul with the easy smile for the rest of my days, but have faith we will be together again. He's just getting a little break from me!

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    Hi pbj and all
    Here's an update on E and our visit to the consultant. She did look over his records, and apologised that it had taken so long to address the fluid on his lungs. Other than that, things aren't looking too great just now. E's scan showed that not much has changed since before his chemo, the cancer hasn't progressed or changed much, and has certainly not reduced. They were not at all keen on him having more chemo, partly because of the problems he's had with his low blood counts which they felt were quite dangerous, and partly because he now weighs only 121 pounds. I think he's lost somewhere in the region of 50 pounds over the last 3 months, even though he's now eating pretty well. E is not ready in his mind to move on to palliative care only, and so he wants to carry on having chemo, maybe at a reduced dose. The consultant sent him for an x ray at the end of the visit, she's going to have a look at that and at his blood counts and phone him tomorrow to talk about it some more, but maybe they'll carry on with the chemo.

    So now we're either going to be doing more chemo which the doctor thinks is risky and of limited benefit, or stopping active treatment. They said it would give him a few more months if he has the chemo, and he's determined to keep going. I'm glad he's so strong, but I'm a bit down today, wishing it was all a bit more positive! I know he's going to have a really hard time with this chemo if it goes ahead. However, never despair! Despite being thin and pretty weak, he's feeling good just now. We'll keep going!
    RBx
    57 year old partner diagnosed in November 09 with Stage IV NSC adenocarcinoma lung cancer. Two rounds of chemotherapy gave very little change. Problems with very low levels of platelets and no further chemo proposed due to his extreme weight loss (over 40lbs). Had 5 sessions of radiotherapy to lung. Sadly passed away in a beautiful hospice March 2010.

    Can't bear to be without you my love, but will try my best to keep going.

  6. #6
    Administrator Top User pbj11's Avatar
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    Ruthie,

    I'm sorry that the scans aren't showing a change. Sorrier yet that he's having such a rough reaction in his blood counts. He's a fighter and you have to go with his wanting to fight. Months gained may not seem like much, but weeks and days begin to take on significance.

    I hope they are swapping out the chemo drugs to something completely different. Do you know what they have in mind for second line treatment? Did he have any tumor material tested to see if he has the EGFR mutation and would respond to Tarceva? I'm just hoping that they have a good game plan, as time is so important when his weight is getting this low.

    His cancer is battling his body for the calories and he sounds like he has Cachexia. If he gets on a regimen that works, you'll see his weight trend back up.

    Did you ask they why they didn't give him blood enhancers after his first two rounds of chemo and are they planning to if he starts again?

    Take care sweetie --- I know how hard this is on both of you. We're here to hold you up and offer prayers.

    God bless,
    PBJ
    Husband diagnosed with NSCLC Stage IV in 3/2005. Fought & lived over 2 1/2 years with multiple lines of treatment.

    Post describing our journey: http://cancerforums.net/viewtopic.ph...er=asc&start=0

    Left my embrace to live with our Heavenly Father in October of 2007 and now breathes with ease forever. I will miss this gentle, giving soul with the easy smile for the rest of my days, but have faith we will be together again. He's just getting a little break from me!

  7. #7
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    Hi pbj
    They did talk about a biological med, but they didn't use the brand name. From looking it up, I"m pretty sure it was tarceva. They offered it to him instead of more chemo, but he's still thinking about the chemo. It's good to know we could have tarceva for later.

    I think they didn't use blood enhancers because he hasn't had a problem with his white blood cells. The treatments for red blood cell counts are only used here for certain cancers, for lung cancer they prefer to just give transfusions as they think it's more effective. He likes getting the red blood cells so he's quite happy with that just now!

    I read about cachexia, it's hard to tell because so much has been going on but it does seem likely that's a factor. He doesn't know about it, and I don't want to depress him by talking about it. I've told him lots about his metabolic rate being up and so on. He's resolved to eat non stop, and I've told him he has to race the cancer to get in more calories than it can use up.

    The nurse is coming shortly to check on things and cheer him on, so I'd better go and tidy up!
    love to all, hope this is a good day for everybody
    RBx
    57 year old partner diagnosed in November 09 with Stage IV NSC adenocarcinoma lung cancer. Two rounds of chemotherapy gave very little change. Problems with very low levels of platelets and no further chemo proposed due to his extreme weight loss (over 40lbs). Had 5 sessions of radiotherapy to lung. Sadly passed away in a beautiful hospice March 2010.

    Can't bear to be without you my love, but will try my best to keep going.

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    A slight update on that - the consultant phoned today, and taking into account E's desire to carry on vigorously treating his cancer, they're going to start giving him radiotherapy on his main tumour next week. She thinks this will improve his breathing, as although it's not too bad just now, the tumour is encroaching slightly on his airway. Hopefully this will both improve his breathing and reduce the pains he has in his back, and stop things getting worse in the future too.

    I don't think this does too much with the fluid problems, but we're very glad that he's still getting active treatment, and hope that the radiotherapy won't knock him about the way the chemo did! We still have the Tarceva to come back to later on as well, so today we're feeling optimistic.
    RBx
    57 year old partner diagnosed in November 09 with Stage IV NSC adenocarcinoma lung cancer. Two rounds of chemotherapy gave very little change. Problems with very low levels of platelets and no further chemo proposed due to his extreme weight loss (over 40lbs). Had 5 sessions of radiotherapy to lung. Sadly passed away in a beautiful hospice March 2010.

    Can't bear to be without you my love, but will try my best to keep going.

  9. #9
    Administrator Top User pbj11's Avatar
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    Ruthie,

    Good deal! Once the tumor shrinks away from the bronchial passage, that will help with the breathing. Chemo did that for my husband and it made a world of difference. There are side effects from the radiation too --- especially the closer to the mid-chest area they get. (It can also irritate the lung, making the effusion happen again. Like getting worse before getting better.)

    Make sure the doc runs through all the various side effects with you. My husband only did 15 sessions for a tumor that grew while all the rest were shrinking, so didn't have too rough of a time with the rads.

    Keep us posted and let us know if you need any info.

    Hugs to you,
    PBJ
    Husband diagnosed with NSCLC Stage IV in 3/2005. Fought & lived over 2 1/2 years with multiple lines of treatment.

    Post describing our journey: http://cancerforums.net/viewtopic.ph...er=asc&start=0

    Left my embrace to live with our Heavenly Father in October of 2007 and now breathes with ease forever. I will miss this gentle, giving soul with the easy smile for the rest of my days, but have faith we will be together again. He's just getting a little break from me!

 
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