Description of Myelosuppression

Myelosuppression as a side effect of chemotherapy is quite common in patients undergoing this treatment. This condition is also called ‘bone marrow suppression’. It is a condition in which the blood cells reduce considerably and the patient becomes anemic. Although it is quite common side effect of chemotherapy, it is considered a serious side effect. The doctors usually keep a close tab on the blood count of patents due to this reason. Myelosuppression can occasionally be caused by non-steroidal anti-inflammatory drugs.

The blood cells are produced in the bone marrow of a person. These cells are of three types; the white blood cells, the red blood cells and the blood platelets. Myelosuppression can cause the reduction of one or two or all the three types of these cells. After starting the chemotherapy treatment, most of the patients experience a reduction in the count of the red blood cells. This is called as anemia.

Many patients also experience a lowered count of the white blood cells. These cells are of two types: granulocytes (consisting of neutrophils, basophils, and eosinophils) and agranulocytes (consisting of lymphocytes, monocytes, and macrophages). A lowered count of the neutrophilis is called neutropenia; it is a sub-category of the myelosuppression. The white blood cells are responsible to protect the body from infection.

When the blood reports of a patient shows a lowered count of the blood platelets then this kind of myelosuppression is termed as thrombocytopenia. This condition is not very common in patients and is found in not more than ten percent of the patients undergoing chemotherapy. Although this condition does not cause pain to patients, it can result in low energy levels, and makes them prone to infections. Because of a lowered platelet count, when these patients bleed, it does not stop as quickly as it would in a healthy person.

Causes of Myelosuppression

In a majority of the patients, myelosuppression is caused by the cytotoxic drugs used for chemotherapy treatment. They are also caused by cancerous cells, therapeutic x-rays and in some rare cases even non-cytotoxic drugs. These cytotoxic drugs may affect a person directly as well as indirectly. The cytotoxic drugs cause nutritional deficiencies due to which this condition might occur in a person. It may occur if the cancer invades the bone marrow and affects the production of the blood cells in a normal manner. The cancer can also cause myelosuppression without invading the bone marrow.

Myelosuppression often occurs after a period of seven to ten days after the bone marrow is affected. This damage is reversible and the bone marrow usually returns to normal in the next few weeks. In some cases this harm can be permanent and can cause a lot of damage to the body. This is usually seen if a person is exposed to a very intensive chemotherapy.

Most of the cytotoxic drugs are known to cause myelosuppression; but there are some commonly known drugs that cause this condition. Fluoroucil and capecitabine are known to cause all types of myelosuppression; oxaliplatin is associated with neutropenia and thrombocytopenia; and irinotecan is known to cause neutropenia. Some cytotoxic drugs do not cause myelosuppression when they are given alone. However, when they are given in combination with other cytotoxic drugs, they might cause bone marrow suppression. Myelosuppression is also caused when the cytotoxic drugs are given with bolus instead of giving it through infusion over a period of time.

Symptoms of Myelosuppression

Myelosuppression does not cause any pain, but it does have many side effects, which occur because of the decrease in the count of the blood cells. This is harmful for the health of a person. Most of the side effects of myelosuppression do not pose any threat to the life of a person, but it does affect the quality of life  when this condition is extensive.
The symptoms of myelosuppression depend on the type of blood cells that become deficient. If a person has anemia because of a low count of the red blood cells, then that person can experience dizziness, fatigue, and shortness of breath. It might even cause pale skin in a person; the skin at the nail beds and the lips become prominently pale. In rare cases, it can also increase the heart beat of a person.

People suffering with low count of white blood cells will have neutropenia. This will make the person more prone to infections. Because of this, they are likely to have fever, sore throat, mouth ulcers, swelling around a wound, or even a burning sensation while urinating. They can also develop rashes, and redness around a part of the body.

People suffering from thrombocytopenia become prone to nose bleeds or bleeding gums. If they have a cut or a wound, they do not stop bleeding quickly. They also experience fatigue and weakness.

Treatment for Myelosuppression

If the symptoms of myelosuppression are very mild, then it does not require much treatment. In cancer patients, if myelosuppression is caused by chemotherapy treatment (because of cytotoxic drugs) or because of radiation therapy, then the oncologists might extend the rest period for the patients (the interim period between two cycles) or they can stop or reduce the dosage of the cytotoxic drugs.
The oncologist s might also consider giving blood transfusions to patients suffering from myelosuppression. The blood given to a patient is packed with red blood cells or even platelets. This treatment usually has to be repeated as the transfused blood cells are short lived. White blood cells cannot be given through transfusions. In some cases, bone marrow transplants might be required.

Minimizing the Symptoms of Myelosuppression

The cancer patients are usually guided by their oncologist as to how to minimize the symptoms mentioned above. Some of these are: stay away from people who have any infections, do not exert yourself too much, have a nutritional diet, abstain from smoking and consuming alcohol, wash your hands regularly to avoid infection, and drink plenty of fluids.