Your bone marrow makes cells called platelets. These cells keep you from bleeding too much by helping your blood clot. Chemotherapy, radiation, and bone marrow transplants can destroy some of your platelets and the cells in your bone marrow that make them. This can lead to bleeding during cancer treatment.

Cancer treatment - bleeding; Chemotherapy - bleeding; Radiation - bleeding; Bone marrow transplant - bleeding; Thrombocytopenia - cancer treatment

If you do not have enough platelets, you may bleed too much. Everyday activities can cause this bleeding. You need to know how to prevent bleeding and what to do if you are bleeding.

Talk with your health care provider before you take any medicines, herbs, or other supplements. Do not take aspirin, ibuprofen (Motrin, Advil), naproxen (Aleve), or other medicines unless your provider tells you it is OK.

Be careful not to cut yourself.

• Do not walk barefoot.
• Use only an electric razor.
• Use knives, scissors, and other tools carefully.
• Do not blow your nose hard.
• Do not cut your nails. Use an emery board instead.

Take care of your teeth.

• Use a toothbrush with soft bristles.
• Do not use dental floss.
• Talk with your provider before getting any dental work done. You may need to delay the work or take special care if you have it done.

Try to avoid constipation.

• Drink plenty of fluids.
• Eat plenty of fiber with your meals.
• Talk with your provider about using stool softeners or laxatives if you are straining when you have bowel movements.

To further prevent bleeding:

• Avoid heavy lifting or playing contact sports.
• Do not drink alcohol.
• Do not use enemas, rectal suppositories, or vaginal douches.

Women should not use tampons. Contact your provider if your periods are heavier than normal.

If you cut yourself:

• Put pressure on the cut with gauze for a few minutes.
• Place ice on top of the gauze to help slow the bleeding.
• Contact your provider if the bleeding does not stop after 10 minutes or if the bleeding is very heavy.

If you have a nosebleed:

• Sit up and lean forward.
• Pinch your nostrils, just below the bridge of your nose (about two-thirds down).
• Place ice wrapped in a washcloth on your nose to help slow the bleeding.
• Contact your provider if the bleeding gets worse or if it does not stop after 30 minutes.

Contact your provider if you have any of these symptoms:

• A lot of bleeding from your mouth or gums
• A nosebleed that does not stop
• Bruises on your arms or legs
• Small red or purple spots on your skin (called petechiae)
• Brown or red urine
• Black or tarry-looking stools, or stools with red blood in them
• Blood in your mucus
• You are throwing up blood or your vomit looks like coffee grounds
• Long or heavy periods (women)
• Headaches that do not go away or are very bad
• Blurry or double vision
• Abdominal pains

Doroshow JH. Approach to the patient with cancer. In: Goldman L, Cooney KA, eds. Goldman-Cecil Medicine. 27th ed. Philadelphia, PA: Elsevier; 2024:chap 164.

National Cancer Institute website. Bleeding and bruising (thrombocytopenia) and cancer treatment. www.cancer.gov/about-cancer/treatment/side-effects/bleeding-bruising. Updated December 29, 2022. Accessed May 28, 2024.

National Cancer Institute website. Chemotherapy and you: support for people with cancer. www.cancer.gov/publications/patient-education/chemotherapy-and-you.pdf. Updated January 2024. Accessed May 28, 2024.

National Cancer Institute website. Radiation therapy and you: support for people with cancer. www.cancer.gov/publications/patient-education/radiation-therapy-and-you.pdf. Updated April 2021. Accessed May 28, 2024.