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Bruising and bleeding in cancer patients

The information on this page was reviewed and approved by
Maurie Markman, MD, President, Medicine & Science at CTCA.

This page was updated on September 21, 2021.

Cancer and cancer treatment may cause many different side effects, including bruising and bleeding.

A condition called thrombocytopenia may decrease the number of cells that assist with blood clotting to stop bleeding. These cells are called platelets. If you have a low platelet count, it’s easier for you to bruise or bleed. You also may have small red or purple spots on your skin.

Why are bruising and bleeding side effects of cancer and cancer treatment?

There are a few reasons why you may experience thrombocytopenia, or more bruising and bleeding, when you have cancer.

  • Antibodies: Antibodies help to kill things such as bacteria and viruses, but they sometimes kill healthy platelets.
  • Chemotherapy: This type of therapy may damage bone marrow, or the tissue in your bones where platelets are made.
  • Specific types of cancer: Leukemia and lymphoma may decrease your platelet count. Also, cancer that has spread to the bone may lead to thrombocytopenia because the cancer cells may make it hard for bone marrow to produce more platelets. Cancer in the spleen may lead to bleeding issues because the spleen typically stores extra platelets. Cancer may make the spleen bigger, causing it to hold on to those platelets instead of circulating them elsewhere in the body.
  • Radiation therapy: Although radiation therapy doesn’t typically lead to a low amount of platelets, your platelet levels may decrease if you receive both chemotherapy and radiation therapy, or if you’re getting a large amount of radiation therapy to your pelvic area.
  • Surgical site bruising and bleeding: If you’ve had surgery for cancer, it’s not uncommon to notice bruising near the surgical site or the leakage of some blood. This isn’t necessarily thrombocytopenia. Follow any instructions on caring for a surgical site wound. If it’s bleeding a lot, let your surgeon know or seek immediate medical care.

Symptoms of bruising and bleeding from cancer and cancer treatment

Symptoms of thrombocytopenia include the following:

  • Bleeding from areas such as the mouth, nose or rectum
  • Bloody spit or vomit
  • Bruises on the skin that come from unknown causes
  • Heavy vaginal bleeding during menstrual periods
  • Joint or muscle pain
  • Purple or red dots on your skin
  • Urine that has a brown, pink or red color
  • Stools that have blood in them, making them look bright or dark red, or even black
  • Weakness
  • Severe headaches
  • Vision changes

Let your care team know if you’re experiencing any of these symptoms.

Treating bruising and bleeding from cancer treatment

There are some treatments your care team may use if you have thrombocytopenia.

If you need surgery but your platelet count is low, you may need to wait until your platelet counts become higher. This will help cut the risk of heavy bleeding.

If you have low platelets due to chemotherapy, your doctor may change your treatment. This could include a lowered chemotherapy dose or adding more time between treatments. A drug called oprelvekin may be used to help prevent low platelet count.

If you have a very low platelet count, your doctor may order a transfusion of platelet cells. This is when you receive donor platelets in your blood through an infusion. It may help temporarily prevent heavy bleeding. The effects from transfusions usually last about three days. Transfusions may help treat or prevent heavy bleeding, but there are some potential risks. These include:

  • Transfusion reaction, which may look like an allergic reaction
  • Transfusion-related lung injury, which may cause breathing problems
  • Exposure to human immunodeficiency virus (HIV), hepatitis B or hepatitis C

Ask your care team about the benefits and risks of a transfusion.

How to prevent bruising and bleeding

If you have thrombocytopenia, make sure to take certain steps to lower your risk for bleeding and bruising.

  1. Avoid physical activity that could lead you to have an injury, including contact sports.
  2. Do your best to protect your skin against scrapes and sharp objects.
  3. Use a soft toothbrush. A hard toothbrush may irritate your gums.
  4. When shaving, use an electric razor.
  5. Find out from your dentist or care team if it’s OK to floss.
  6. When you have to blow your nose, do so gently.
  7. Do your best to not strain during a bowel movement. Using a stool softener may help with this. If you get constipated, let a member of your care team know.
  8. Avoid putting anything in your rectum, such as enemas or suppositories.
  9. If you get a nosebleed, sit up with your head tilted forward. You may place ice on your nose and pinch your nostrils shut for five minutes to help reduce bleeding.
  10. Use a washcloth or paper towel to press on any areas of bleeding.
  11. Wear shoes even inside your home to reduce your chance of a cut or scrape on one of your feet.
  12. Ask your care team about any medications you should avoid that may increase your risk for bleeding. This may include medicines with aspirin or ibuprofen.
  13. Use sharp objects—such as a knife, a needle or scissors—with extra care.
  14. Seek urgent medical attention if you’re bleeding a lot more than usual or if you have trouble stopping the bleeding.

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