Reduced blood counts

Chemotherapy can reduce your red and white blood cell count, as well as platelets. This decrease can cause problems that include:

  • Anemia: A shortage of red blood cells or hemoglobin can cause anemia, which prevents your blood from carrying enough oxygen to the body. If the anemia becomes severe, you may need a blood transfusion. Symptoms can include fatigue, shortness of breath, dizziness, or pale skin.
  • Low white blood cell count: If your white blood cell count is too low, your body is less able to fight off infections. If you develop an infection, you may need antibiotics, and/or a hospital stay. Many regimens reduce your counts. It is important to report a fever of more than 100.4°F (38°C). If your white blood cell count, specifically your ANC, is too low, you may be experiencing a medical emergency that requires hospitalization.
  • Low platelet counts: Report any bruising or bleeding that does not stop.

Low white blood cell count

Your white blood cells are your infection fighting cells (immune system). Your risk may be elevated by the type of treatment you receive. In general, the more chemotherapy you receive the more at risk your bone marrow is for low white blood cell counts.

White cells typically go down to their lowest approximately 7 to 10 days after chemotherapy and then start to recover. This is known as the nadir.


Please ensure that you have a good digital thermometer available at home. Fever is often the only sign of infection. Call us at 650-498-6000 if you have a temperature higher than 100.4°F (38°C).

If you ever have a fever at home greater than 100.4°F (38°C) you need to call our office day or night. 650-498-6000.

Fevers can be a sign of infection and if your white count is low it is difficult for your body to fight infection. With fevers, we will likely ask you to come in to have your blood counts checked.

If your blood counts are getting too low before each treatment we may use a medication to help stimulate your bone marrow to make more white blood cells. An occasional delay in treatment may be necessary.

Neupogen® (filgrastim) 300 mcg subcutaneous injection

This medication is given by injection daily for 3 to 7 days as instructed. The nurses will teach you or a family member how to do the injections at home. It is used to help prevent your white blood cell count from getting too low and helps to prevent fever and infections associated with low white blood cell counts. This is used only when we are concerned about low white blood cell counts. It is not used with every chemotherapy regimen.

This medication can cause body ache and bone pain (back/chest/long bones). The pain can be alleviated by taking Claritin® (loratadine) the day before the injection and for 2 to 3 days after. You may also use Tylenol® (acetaminophen) or Motrin® (ibuprofen) as needed for pain.


This common side effect of cancer treatment can increase as therapy progresses. Fatigue can continue even after your treatment is complete.

If fatigue becomes severe, we can prescribe medications to help you. We can also adjust your systemic treatment dosage or schedule, if needed.

While you are receiving systemic therapy, we encourage:

  • Frequent, regular exercise and rest
  • Good sleep habits