Bone Marrow Suppression During Cancer Treatment in Children

What is bone marrow suppression in children?

Bone marrow is spongy tissue inside some of the larger bones. It makes most of the body’s blood cells. Bone marrow suppression is when fewer blood cells are made in the marrow. It’s a common side effect of some strong medicines, such as chemotherapy. Bone marrow suppression can cause:

• Anemia. This is a decrease in red blood cells, which carry oxygen.
• Neutropenia. This is a decrease in neutrophils. These are a type of white blood cell that fight infection.
• Thrombocytopenia. This is a decrease in platelets. These are cells that help stop bleeding.
• Pancytopenia. This is a decrease in all of these types of blood cells.

What causes bone marrow suppression in a child?

Chemotherapy medicines make it harder for the bone marrow to make blood cells the way it normally does. Nearly all chemotherapy medicines cause a drop in blood cell counts. The drop in blood cell counts varies depending on which medicines are used for your child's treatment. Radiation therapy cancer treatment can also sometimes suppress bone marrow.

Which children are at risk for bone marrow suppression?

A child is more at risk for bone marrow suppression if he or she is having chemotherapy treatment for cancer.

What are the symptoms of bone marrow suppression in a child?

Symptoms can occur a bit differently in each child.                                                                                                                                 

Symptoms of low platelets (thrombocytopenia) can include:

• Easy bruising
• Bleeding from the nose, gums, or mouth
• Tiny red spots on the skin (petechiae)
• Blood in the urine
• Dark or black bowel movements

Symptoms of low white blood cells (neutropenia) can include:

• Fever and chills
• Rash
• Diarrhea
• Mouth sores
• Sore throat or pain when swallowing
• Pain or burning when passing urine
• Cough or shortness of breath
• Signs of infection anywhere in the body such as swelling, pus, redness, warmth

Symptoms of low red blood cells (anemia) can include:

• Tiredness that doesn't get better with rest
• Pale skin, lips, and nail beds
• Increased heart rate
• Tires easily with exertion
• Dizziness
• Weakness
• Shortness of breath

The symptoms of bone marrow suppression can be like other health conditions. Make sure your child sees his or her healthcare provider for a diagnosis.

How is bone marrow suppression diagnosed in a child?

A child’s blood cell counts are checked regularly when a child is having chemotherapy treatment. Many parents like to keep track of their child's blood counts to record their progress. Ask your child's healthcare provider what levels are acceptable for your child during cancer treatment.

How is bone marrow suppression treated in a child?

Treatment for bone marrow suppression will depend on your child’s symptoms, age, and general health. It will also depend on how severe the condition is. While your child is having chemotherapy treatment, his or her blood cell levels will be checked often. Your child may be given medicines to help the bone marrow make more blood cells. Talk with your child’s healthcare providers about the risks, benefits, and possible side effects of all medicines.

To help prevent bleeding, have your child:

• Not do strenuous activity, contact sports, or heavy lifting

• Not blow his or her nose too hard or cough hard
• Not eat raw vegetables or foods that are hard, rough, or scratchy
• Not shave any part of the body

To help prevent infections, have your child:

• Use an antiseptic mouthwash without alcohol
• Keep all scratches clean and covered
• Wash his or her hands often
• Not eat raw or pre-cut fruits and vegetables, which can have bacteria
• Keep away from crowds and sick people

Check your child's temperature every day for signs of a fever. Ask the healthcare provider what you should do if it goes up and when you should call the provider. 

Also make sure your child:

• Doesn’t have any alcohol, such as in cough and cold medicines
• Balances rest and activity
• Eats high-protein foods
• Drinks plenty of fluids

What are the possible complications of bone marrow suppression in a child?

Bone marrow suppression can cause extreme tiredness (fatigue), infection, and bleeding.

When should I call my child’s healthcare provider?

Call the healthcare provider if your child has:

• Fever (see Fever and children section below).

• Bleeding that doesn’t stop
• Symptoms that don’t get better, or get worse
• New symptoms that concern you

Fever and children

Always use a digital thermometer to check your child’s temperature. Never use a mercury thermometer.

For infants and toddlers, be sure to use a rectal thermometer correctly. A rectal thermometer may accidentally poke a hole in (perforate) the rectum. It may also pass on germs from the stool. Always follow the product maker’s directions for proper use. If you don’t feel comfortable taking a rectal temperature, use another method. When you talk to your child’s healthcare provider, tell him or her which method you used to take your child’s temperature.

Here are guidelines for fever temperature. Ear temperatures aren’t accurate before 6 months of age. Don’t take an oral temperature until your child is at least 4 years old.

Infant under 3 months old:

• Ask your child’s healthcare provider how you should take the temperature.
• Rectal or forehead (temporal artery) temperature of 100.4°F (38°C) or higher, or as directed by the provider
• Armpit temperature of 99°F (37.2°C) or higher, or as directed by the provider

Child age 3 to 36 months:

• Rectal, forehead, or ear temperature of 102°F (38.9°C) or higher, or as directed by the provider
• Armpit (axillary) temperature of 101°F (38.3°C) or higher, or as directed by the provider

Child of any age:

• Repeated temperature of 104°F (40°C) or higher, or as directed by the provider
• Fever that lasts more than 24 hours in a child under 2 years old. Or a fever that lasts for 3 days in a child 2 years or older.

Key points about bone marrow suppression in children

• Bone marrow is spongy tissue inside some of the larger bones. It makes most of the body’s blood cells.
• Bone marrow suppression is when fewer blood cells are made in the marrow. It can cause a decrease in red and white blood cells, and platelets.
• Nearly all chemotherapy medicines cause a drop in blood cell counts. The drop in blood cell counts varies depending on which medicines are used for your child's treatment.
• Symptoms include easy bruising, bleeding, fever, infection, and tiredness.
• While your child is undergoing chemotherapy treatment, his or her blood cell levels will be checked often. Ask your child's healthcare provider what levels are acceptable for your child.
• Your child may be given medicines to help the bone marrow make more blood cells.

Next steps

Tips to help you get the most from a visit to your child’s healthcare provider:

• Know the reason for the visit and what you want to happen.
• Before your visit, write down questions you want answered.
• At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you for your child.
• Know why a new medicine or treatment is prescribed and how it will help your child. Also know what the side effects are.
• Ask if your child’s condition can be treated in other ways.
• Know why a test or procedure is recommended and what the results could mean.
• Know what to expect if your child does not take the medicine or have the test or procedure.
• If your child has a follow-up appointment, write down the date, time, and purpose for that visit.
• Know how you can contact your child’s provider after office hours. This is important if your child becomes ill and you have questions or need advice.