Aplasia or myelosuppression may be a consequence of cancer treatments such as chemotherapy or radiotherapy, or even surgery. During these times, the risk of infections are increased. Infections can be very serious because the defences of the body are weakened by the treatments.
In this article, I will give you the definition of aplastic anaemia and its causes, the signs that can identify it and the many steps to take to reduce the risk of infection.
In any case, and whatever the causes of bone marrow suppression, you need specific medical advice so that you can be well cared for and get advice on your personal situation.
In short, I offer a complete article in the lines below. Feel free to read it as many times as you want by saving it in your favourites to get back to easily.
In addition, to facilitate reading, I have integrated videos that seem interesting and relevant.
If you would like to add information or share your experience, feel free to leave a comment at the bottom of this article.
Definition of aplasia (bone marrow suppression) and its causes
Into the bones, the bone marrow produces the white and red blood cells as well as the platelet. Each one of these cells has got a specific and important role in order for the body to function adequately.
In case of low production of these blood cells, we talk about bone marrow aplasia.
Bone marrow aplasia is frequent in the treatments of cancer. That is why a complete blood count is regularly controlled by blood test. The change in the production of blood cells can happen within 7 days after the beginning of the treatments and can become severe.
Here is a video of Johns Hopkins Medicine (youtube.com) presenting the birth and the blood cells function. This process can be altered in certain circumstances, particularly during treatments against cancer:
Bone marrow aplasia is frequently a consequence of chemotherapy against cancer. In its mode of action, chemotherapy will act upon the whole body. It reaches all the body cells including the bone marrow.
Hence, people suffering of cancer are often in a period of bone marrow aplasia.
In order to support them, healthcare teams provide regularly processes and advices in order to limit this risk and to identify warning signs that need a medical opinions.
In addition, here is the definition of the bone marrow aplasia from the National Cancer Institute.
Signs of myelosuppression and symptoms
The symptoms of myelosuppression and its signs are different depending on the type of cells affected: red blood cells, white blood cells and platelets. They all are important and must be followed medically.
I will detail all these three situations, the symptoms and signs of aplasia.
Red blood cells and aplasia
The abnormal production of red blood cells is called aplastic anaemia.
Its symptoms are :
– an extreme pallor of the skin,
– an intense fatigue, exhaustion,
– an irritability with family and surroundings,
– dizziness, vertigo.
Myelosuppression on white blood cells
Myelosuppression is considered when the level of neutrophil polyneclear is less than 500/mm3.
When myelosuppression reaches white blood cells, the risk of infection is high. The body is tired, it no longer has the necessary defences to fight against microbes and bacteria.
As I will describe in the paragraphs below, there are many precautions and procedures to put in place to limit infections or at least reduce this risk.
In case of fever or chills, it will take urgent medical advice.
Myelosuppression and blood platelets
When the change in blood cell production affects blood platelets, the signs and symptoms are as follows:
– bruises appear without cause,
– there is spontaneous bleeding from the nose, gums and mouth,
– small red spots are visible under the skin,
– presence of blood in the urine or in the stool.
Also in this case, you must get a medical opinion without any delay.
Infection and myelosuppression: the steps to take
In the following lines, I will inform you about everything you can do to limit the risk of infection during periods of aplasia.
If you are sick yourself, it would be best to have your loved ones or homecare workers help you. It’s not always possible, but very useful to preserve you. Know that some complementary health, offer home help services after an operation or each course of chemotherapy. To find out if you can benefit from these services, you can read the terms and conditions of your contract.
Being in a period of aplasia
When a person is in aplasia, he will have to avoid all risk situations. So, we must not:
– be in a crowd,
– take public transportation (if you have no other choice, consider wearing a mask and gloves),
– be in an unhealthy place,
– go to the pool, steam room, sauna,
– be with sick people (even if they only have a cold) and avoid very young children (again, if you have no choice, think about wearing a mask and gloves),
– do the housework yourself (if it’s possible).
And be carefull with the chemo port a cath.
Aplasia at home
In times of aplasia, different daily gestures will have to be adapted.
So, at the level to put the procedures and precautions in place, if it’s possible for you, it’s necessary.
– change the sheets of the bed very often, every day or every two days,
– towels should only be used by the patient and changed daily ensuring they dry well between uses (to do this, use a towel warmer or tumble dryer),
– you must not walk with your shoes in the house. Leave them in the hallway and use slippers or comfortable non-slip socks. You will wash them regularly.
– door handles should be disinfected regularly (ideally they are copper… it’s better because it’s a natural bactericide),
– the refrigerator and the cupboards should be cleaned very regularly as well as other everyday objects (remote control, smartphone, computer keyboard, tablet, etc.).
Method for preparing meals during aplasia
In times of aplasia, the preparation of meals must be done with important hygiene measures.
When a person is suffering from myelosuppression, it’s not necessary that the patient eats his/her meals in community (restaurant, canteen). Before preparing meals, always wash your hands (see the video at the end of the article on the method to be applied).
The patient should not eat any leftovers.
The dishes should be seasoned (salt, pepper, spices, condiments) during cooking, never after.
You have to consume the warm dishes without waiting.
Food should be purchased in small packages and consumed quickly.
The work board used for preparing meals must be clean.
Myelosuppressive chemotherapy regimens
In case of myelosuppression due to chemotherapy (or any other causes), all ingredients that have a significant risk of contamination must be avoided, such as:
– sushi, tartare and all raw or undercooked or rare meat or fish,
– shrimp, crab, oysters, and all shellfish and crustaceans,
– cold cuts, smoked meats,
– slightly cooked eggs (including egg yolk). They must be very well cooked,
– frozen dishes and homemade preserves,
– cooked dishes from the caterer (Asian, Italian, etc.),
– fresh bread and all pastries,
– dried fruits.
Deep frozen foods can be consumed if the cooling has been fully respected.
Aplasia : how to clean fruits and vegetables?
During cancer treatments, especially during chemotherapy, eating disorders and nausea may be common.
However, it’s important to eat well to reduce the risk of undernutrition.
In these cases, it’s often advisable to eat neutral foods. Fruits and vegetables can be a good alternative for having substantial meals, therefore the risk of nausea can be reduced.
However, before eating fruits and vegetables, they should be cleaned very well, especially if they are raw.
To clean them well, it will be necessary to wash them with clear water.
Then soak them in a solution of 60 ml of white vinegar per litre of water for at least 15 minutes.
Dry them well with disposable paper towels,
Peel them with a clean, economical knife.
And then eat them immediately.
Here’s a video from ABC15 Arizona that explains in a didactic way how to clean vegetables:
To wash fruits and vegetables, there’s no need to buy expensive and toxic products. Water and vinegar are sufficient in most cases.
Myelosuppression and dishwashing
If there’s a meal, there’s washing dishes. This eternal domestic chore must be respected by certain procedures in cases of myelosuppression.
There are two cases.
The first – and the most simple – is to use a dishwasher. In this case, it must be ensured that the trunk and the grill at the bottom of the machine are always clean.
The second one is to wash the dishes yourself. In this case, first wash them by hand with dish detergent, and rinse them well afterwards.
Then, soak the dishes in one litre of water with a spoonful of bleach for 15 minutes.
Then rinse the dishes very thoroughly and wipe them with a clean cloth (wash after each use).
And, finally, store everything in a clean cupboard that has been cleaned beforehand.
If the patient is washing dishes, it’s better to wear gloves.
Aplasia and the strategy around the choice of the dishes
As a precaution, it’s better for the patient to keep his own dishes. The other family members will not use them. For simplicity and to avoid mixing, it’s useful to use colour codes. For example: have a plate, glasses and blue cups or bowls (or with specific patterns) for the patient, while using white dishes for the other members of the household.
Myelosuppression and personal hygiene to prevent infections
Body hygiene is an important priority in the prevention of infections in cases of myelosuppression.
I will mention some methods here for brushing your teeth, for taking showers and for washing your hands. This last one is a crucial act to reduce the risk of contamination.
Aplasia and tooth brushing
To avoid infections, but also to limit the appearance of ulcers, it’s important to have impeccable oral hygiene.
So, to brush your teeth, it’s helpful to use an « ultra-soft » or « post-operative » toothbrush, which preserves the gums while cleaning your teeth properly. If you have painful lesions in your mouth, ask advice about the use of « Toothette ® ».
It’s advised to change the toothbrush very regularly and to use a very mild toothpaste (without sodium lauryl sulphate), especially if you have ulcers in mouth.
After each use, rinse your toothbrush with a single-use tissue.
During the entire period of aplasia, you must leave your toothbrush in the open air, do not leave it in a drawer or a closet.
And of course, use mouthwashes prescribed by your doctor after each brushing.
Aplasia and taking a shower
The rules of hygiene in case of aplasia are present during all the acts of the daily life.
Therefore, in case of a small wound, even tiny, after shaving the beard for example, it’s imperative to disinfect the area.
In addition, in case of taking a shower, you must respect a specific order, first you soap the upper body, then the lower body and lastly the genitals.
You will have to dry yourself in the same order, with different towels.
For showers, it’s important to have a soft based washing, intended for frequent use.
You will also need to wash your hands before and after using the toilet.
This precaution should also be applied before and after meals.
For the hygiene of the hands, there are methods to respect which I will inform you about.
Procedure for washing hands during aplasia
Hands are essential vectors of contamination.
Whether it’s for the patient or for all the people present in the house (spouse, children, visitors), everyone will have to have an impeccable hand hygiene:
– washing the hands often,
– and using a specific washing technique (as shown in the video below).
During this time of aplasia where hand washes are common, the skin might get irritated. To avoid this, you can use a very mild soap. In France, it’s often recommended to use brands such as La Roche Posay, Vichy, Uriage, Avene. These are products that use water from hot springs known for their dermatological benefits. Some of these products are even organic.
Ask your doctors or pharmacists for hand washing products that you can use regularly without irritating your skin.
Regarding the washing technique, here’s a video on the procedure for washing hands before surgery. This is the method considered the most effective way to eradicate all the microbes, bacteria and fungi present on our hands and vectors of infection. You can use it to wash your hands:
Photo credit on myelosuppression: