After chemotherapy, be sure to do one thing well! Of vital importance!

Lao Wang was discharged after chemotherapy, and the attending doctor repeatedly explained: "After discharge, remember to regularly check blood routines, twice a week"
.
Lao Wang's wife felt very incomprehensible, and muttered in her heart:

"After chemotherapy, my body is weak, and I go to and from the hospital twice a week, which is too tossing!"

"I was already a little anemia, and I still pumped 1~2 tubes of blood every time, and I looked distressed, can I reduce the frequency?"

"In a few days, if your health is better, you won't have to draw blood for testing, right?"

There are many patients with this idea like Lao Wang's wife, so is it "redundant" to draw blood regularly after chemotherapy? Is it possible not to draw blood?

It may seem like a small problem, but in fact, the oncologist has to tell you: life is at stake!

Science is coming! What exactly does a blood test test? Why do you have to check your routine after chemotherapy? What is considered an abnormal blood routine? If there is no discomfort, can I avoid the blood test? One article to solve the confusion!

What exactly does a blood test test?

Blood tests are the three most important cells in the blood, white blood cells, red blood cells, and platelets
.

Among them, white blood cells are the army of the human body, responsible for destroying bacteria and viruses; Red blood cells are the body's transport brigade, responsible for transporting oxygen and nutrients to tissues throughout the body and transporting metabolic waste from the body; Platelets are the rescue team of blood vessels, responsible for repairing broken blood vessels
.

Blood routine is the most common and basic blood test, but it can directly reflect the changes in the patient's blood and help doctors understand what state
the patient's body is in.
There are many test items for blood routine, and we pick the most commonly used introductions:

Routine blood checklist

White blood cell count (WBC)

The most common significance of the white blood cell count is that its value is elevated to indicate possible infection, in addition to other diseases such as leukemia, and its decrease may be aplastic anemia, hypersplenism, severe sepsis
.
Antineoplastic drugs often cause low white blood cell counts, making people susceptible to infections
.

Hemoglobin (HGB), red blood cell count (RBC)

Hemoglobin (HGB), red blood cell count (RBC), these two combined to see whether there is anemia, with HGB as the main judgment basis, antitumor drugs often cause anemia
.

Neutrophil count, percentage of neutrophils

Taken together, the neutrophil count and percentage of neutrophils are elevated in general, indicating that the infection is bacterial and may be large, but other diseases such as granulocytic leukemia can also cause it to be elevated
.

Lymphocyte count, percentage of lymphocytes

Lymphocyte count and lymphocyte percentage are combined, if both are elevated, there is a high possibility of viral infection, or lymphocytic leukemia, etc.
, and its reduction may be
immunocompromised.

Platelet count (PLT)

Platelet count (PLT) greater than normal value belongs to hypercoagulable state, that is, it is easier to form thrombus than normal blood, less than normal value, indicating hypocoagulable state, that is, bleeding tendency, combined with coagulation function tests, if there is a serious bleeding tendency, can not be operated, including various punctures, intervention
.

Each routine blood test is not isolated and sometimes requires multiple items to be combined to make sense
.

Why is it necessary to have my blood routine checked after chemotherapy?

After chemotherapy, blood routine is mainly to see if bone marrow suppression
occurs.
If there is no blood test, it is not known that bone marrow suppression has occurred, timely intervention, and timely adjustment of the chemotherapy regimen may cause death
.

Chemotherapy and bone marrow suppression

Chemotherapy kills cancer cells while also causing heavy damage to normal tissues and organs of the body, including bone marrow, and the related adverse reaction is called myelosuppression, which is manifested as peripheral hemoglobin, white blood cells, neutrophils and platelets falling below
normal levels.

Leukopenia/neutropenia is the most common hematologic toxicity of chemotherapy drugs, and severe neutropenia increases the risk of invasive infection on the one hand, and on the other hand, fever and infection often lead to chemotherapy drug reduction or delayed treatment, which ultimately affects antitumor efficacy
.
It has been reported in the literature that the degree and duration of leukocytes, especially granulocytopenia, are closely related
to the risk of infection and even death in patients.
Especially when neutropenia with fever (FN) occurs, the risk of infection is greatly increased
.
In patients with FN, the incidence of infection or hidden infection is >60%, the incidence of bacteremia is >20%, the fatality rate of FN is high, and the fatality rate of FN in patients with solid tumor, lymphoma and leukemia is 8.
0%, 8.
9% and 14.
3%,
respectively.

When leukocytes / neutropenia occurs, some patients will have a feeling of fatigue, but many patients may not be uncomfortable, if not detected and treated in time by regular blood tests, the original 1-2 degrees of leukocytes / neutropenia may develop to 3-4 degrees, coupled with the patient's own low immunity, serious infections will occur, and treatment will be life-threatening
if not timely.

Thrombocytopenia is also one of the common hematologic toxicities of chemotherapy, and the recovery time is long, often 1-2 weeks, if not treated in time, subsequent treatment will affect subsequent treatment, and severe thrombocytopenia can lead to fatal events
such as spontaneous intracranial or visceral bleeding.

Red blood cells have a long half-life, are less affected by chemotherapy, and usually decline significantly for a short time, but once anemia develops, recovery also takes longer
.
Therefore, regular blood tests are required for observation, and the degree of anemia and the type of anemia are corrected in time according to the results of laboratory results when anemia related to tumor chemotherapy occurs, so as not to affect subsequent treatment
.

Why are blood tests so frequent?

Because your blood routine information is not static, but is constantly changing
.
In order to detect in time, the doctor will repeatedly explain that the patient needs to regularly review the blood routine after chemotherapy (usually the 3rd day and 7th day after chemotherapy).

Decrease in neutrophils

Neutropenia usually begins one week after the end of chemotherapy, reaches its lowest point 10 to 14 days after stopping the drug, slowly recovers after 2 to 3 days of low levels, and returns to normal on days 21 to 28, becoming U-shaped
.

Thrombocytopenia

Platelet lowering appears slightly later than granulocytopenia, falling to its lowest value about two weeks or so, and its decline is rapid, rapidly rebounding, and V-shaped
.

Decreased red blood cells

The decline in red blood cells occurs later, so no change is usually observed one week after chemotherapy, and regular blood tests are required after chemotherapy treatment
.

Which blood routine is abnormal and requires intervention?

At present, the classification of bone marrow suppression after chemotherapy adopts the World Health Organization criteria for acute and subacute toxicity of anticancer drugs (table below).

In this grade, two key points to pay attention to are that the absolute value of neutrophils is less than 1×10 9/L, and the second is that the platelet count is less than 50×10⁹/L
.
They are the cut-off points for grade 3 granulocytopenia and grade 3 thrombocytopenia, respectively, and are signals of susceptibility to complications and indications for intervention
.

If the blood routine is abnormal, how will the oncologist intervene?

Leukopenia intervention

Leukopenia poses a corresponding risk of infection, and patients may present with fever, typically including physical cooling, use of antipyretic drugs, and maintenance of water-electrolyte balance
.
If the patient develops bone marrow II suppression before day 14 of the chemotherapy interval, granulocyte colony-stimulating factor (G-CSF)
is required.
For patients with bone marrow IV suppression, prophylactic antibiotics can be used to prevent infection until myelosuppression improves, and if antibiotics with a wider antibacterial spectrum may easily cause fungal superinfection and intestinal flora disorders, so narrow antimicrobial spectrum antibiotics
are generally selected.
Effective antibiotics
can be selected based on blood bacterial culture and susceptibility test results.

Hemoglobin reduction interventions

Hemoglobin is reduced, erythropoietin (EPO) is used to promote the proliferation of red blood cells while iron supplementation corrects anemia, and when hemoglobin is less than 70 g/L, transfusion of suspended red blood cells in transfusion therapy can rapidly increase hemoglobin levels
.

Thrombocytopenia interventions

Thrombocytopenia causes an increased risk of bleeding, skin and mucous membrane bleeding, severe can cause visceral bleeding, so patients with thrombocytopenia should reduce activity, prevent bumping, keep stool smooth, avoid coughing and other behaviors
.
Platelet transfusion therapy can effectively increase platelets, but exogenous platelets only live for about
3 days.
Therefore, thrombopoietin (TPO) and interleukin-11 (IL-11) are also used clinically to increase platelets, which can stimulate the production of bone marrow hematopoietic stem cells and megakaryo progenitor cells, thereby increasing platelet production
.

If there is no special discomfort, does it not need to draw blood?

It is also incorrect for many patients to have normal blood routine results after the first chemotherapy test, believing that they can tolerate the side effects of chemotherapy, and not regularly reviewing after the end of subsequent courses of chemotherapy
.
Due to the accumulation of chemotherapy drugs, the incidence and severity of adverse reactions may gradually increase
as the chemotherapy cycle increases.

Prevention or treatment of neutropenia is fundamental
to ensuring adequate or intensive chemotherapy.

Therefore, regular review of blood routine can timely find abnormalities of blood cells, timely treatment, try to avoid the occurrence of danger, and also ensure that intravenous chemotherapy can be carried out normally in full doses and courses
.

Write at the end

Many people think that checking blood routine after chemotherapy is both a waste of money and a waste of blood
.
Looking at the lifting arrows in the report ↑↓, confused
.
In fact, routine blood examination is extremely important for chemotherapy patients and can be called "life-threatening"
.

References

[1] Kuderer N M, Dale D C, Crawford J, et al.
Mortality, morbidity, and cost associated with febrile neutropenia in adult cancer patients.
[J].
Cancer, 2006, 106(10):2258.

[2] Chinese Society of Clinical Oncology Guidelines Working Committee.
Guidelines for the standardized management of tumor chemoradiotherapy-related neutropenia[J].
Chinese Journal of Oncology, 2017(11).

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