Managing Bone Marrow Suppression in Children

What is bone marrow suppression?

Nearly all chemotherapy agents cause a drop in blood cell counts. This is because the chemotherapy makes it harder for the bone marrow to make blood cells the way it normally does. This is called bone marrow suppression. The drop in blood cell counts varies according to which agents are used for your child's treatment. Red blood cells that carry oxygen, white blood cells that fight infection, and platelets that control bleeding are usually lowered with chemotherapy use. Risk for anemia, fatigue, infection, and bleeding are increased with bone marrow suppression. Common terms that you may hear that refer to blood cell reduction include the following:

• Anemia. This is a decrease in red blood cells.

• Neutropenia. This is a decrease in neutrophils (a specific type of white blood cell; a main defender of bacteria).

• Thrombocytopenia. This is a decrease in platelet counts.

• Pancytopenia. This is a decrease in all types of blood cells--red blood cells, white blood cells, and platelets.

While your child is undergoing chemotherapy treatment, these blood cell levels will be monitored frequently. Many parents like to keep track of their child's blood counts to record their progress. Ask your child's doctor what levels are acceptable for your child.

What are symptoms of bone marrow suppression?

The following are the most common symptoms of bone marrow suppression. However, each child may experience symptoms differently. Symptoms may include:

• Low platelets:

  • Easy bruising

  • Bleeding: nose bleeds, gums, or mouth

  • Tiny red spots on the skin (petechiae)

  • Blood in the urine

  • Dark or black bowel movements

• Low white blood cells:

  • Fever and chills

  • Rash

  • Diarrhea

  • Sore throat

  • Pain or burning when passing urine

  • Cough or shortness of breath

  • Signs of infection (anywhere in the body):

    • Swelling

    • Pus or drainage

    • Redness

    • An area that is warm to touch

• Low red blood cells:

  • Fatigue (extreme tiredness that doesn't get better with rest) 

  • Paleness of skin, lips, and nail beds

  • Increased heart rate

  • Tires easily with exertion

  • Dizziness

  • Weakness

  • Shortness of breath

Treatment and prevention of complications of bone marrow suppression

There are several things you can do for your child to prevent complications of bone marrow suppression. Your child may be given specific medications to help stimulate the production of cells in the bone marrow. While you are waiting for your child's blood counts to return to a healthy range, consider the following:

• Your child should avoid strenuous activity, contact sports, or heavy lifting.

• Avoid having your child blow his or her nose or forcefully cough.

• Avoid harsh, raw vegetables, or foods with rough surfaces in your child's diet.

• Do not allow your child to consume alcohol.

• Help your child balance rest and activity. 

• Encourage your child to eat high-protein foods.

• Have your child use an antiseptic mouthwash without alcohol.

• Encourage your child to drink plenty of fluids.

• Keep all scratches clean and covered.

• Girls should not shave their legs or underarms; boys should not shave facial hair.

• Make sure your child, and anyone who comes in close contact with your child, washes his/her hands frequently.

• Avoid uncooked fruits and vegetables, as they can transmit bacteria.

• Avoid coming in contact with anyone who is ill with a contagious disease.

• Keep your child away from crowds. 

• Monitor your child's temperature and ask the doctor what you should do if it goes up.