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Bleeding and Bruising

Certain cancers and cancer treatments can cause bleeding problems, bruising, and tiny purple or red spots on patients’ skin. These signs can occur because the level of platelets in the blood has dropped. Platelets help form blood clots to stop or slow bleeding.

A lower than normal level of platelets in the blood is called thrombocytopenia. A normal platelet count is between 150,000 and 300,000.

It is important to tell the care team right away if your child has bleeding problems, unusual bruising, or tiny purple or red spots. These spots are called petechiae.

Sometimes a low platelet count can cause more serious symptoms:

  • Bleeding that does not stop after a few minutes
  • Bleeding from the mouth, nose, or when throwing up
  • Bleeding from the vagina when not menstruating
  • Bleeding during menstrual period that is heavier or lasts longer than normal
  • Urine that is red or pink
  • Stools that are black or bloody
  • Bad headaches
  • Vision changes
  • Feelings of confusion or sleepiness

Families should tell the care team about any of these signs and symptoms.

Diagnosis of Bleeding and Bruising Problems

Doctors must first decide the cause of bleeding. Tests may include:

  • Physical exam and medical history – The care provider will look for signs of bleeding and feel the abdomen to see if the spleen is enlarged.
  • Complete blood count (CBC)
  • Blood clotting tests – These tests are sometimes called a coagulation panel. They check proteins in the blood that affect the clotting process.

Doctors may perform a bone marrow aspiration to find the cause of thrombocytopenia.

Treatment of Thrombocytopenia

Serious cases of thrombocytopenia may require:

  • Treating the underlying condition — For example, if the low platelet count is caused by a medicine side effect, stopping the medicine might resolve the problem.
  • Transfusions — A transfusion replaces lost platelets with new ones. These donated platelets are given to the patient by vein either through a central venous access device or an IV.

Ways to Prevent Bleeding and Bruising in Childhood Cancer Patients

Patients and families can take steps to prevent bleeding and bruising:

  • Avoid certain medicines and herbal products. Many over-the-counter medicines contain aspirin or ibuprofen, which can increase the risk of bleeding. Certain herbs can also affect bleeding. Your care team will likely provide a list of medications and herbal products to avoid. If not, ask for one.
  • Brush teeth gently with a very soft toothbrush.
  • Wear shoes, even when inside.
  • Be extra careful when using sharp objects. Older patients who shave should use an electric shaver, not a razor.
  • Use lotion and lip balm to prevent dry skin and chapped lips.
  • Avoid physical activities that may result in bruising or injury.
  • Do not take body temperature rectally.
  • Do not pick at scabs or pimples.
  • Menstruating girls should use sanitary pads instead of tampons.

Home Care Tips

Home care for bleeding or bruising include:

  • Gum bleeding — Rinse mouth with ice or cold water.
  • Nose bleeding — While your child is sitting up straight, apply pressure to the outsides of each nostril, just below the bridge of the nose. Pinch the area with the thumb and finger and hold gentle pressure for 5-10 minutes.
  • Other bleeding — Apply gentle pressure with a clean cloth to the area until bleeding stops.
  • Bruising — Put ice on the area for about 20 minutes.

If bleeding does not stop after 5-10 minutes, alert the care team.

Reviewed: September 2018