Keypoints

Low numbers of blood cells

Patients with non-Hodgkin's lymphoma can suffer from low numbers of blood cells, either as a result of the disease itself or its treatment. The main types of blood cells are red blood cells, platelets and white blood cells, and low numbers of each of those in the blood result in different conditions.

Anaemia results from low number of red blood cells, which often makes patients very tired and lethargic, and breathless. This is because the amount of oxygen being carried around your body is decreased. If a patient has symptoms of anaemia or is having treatment for cancer, the lymphoma team will order a blood test to check your haemoglobin level, which is known as a full blood count.

If the patient is found to be suffering from anaemia, it can be treated by prescribing extra iron, which rarely alleviates the symptoms completely, giving a blood transfusion or using drug therapy to increase the production of red blood cells. The lymphoma team may also suggest changes to the patient's diet, in particular, recommending food such as red meat, spinach and fortified cereals, all of which contain iron.

Thrombocytopoenia is where the number of platelets in the blood is abnormally low, causing bruising, nosebleeds or bleeding from the mouth, and pinpoint red spots, which are known as petechial rash.

Patients can also develop internal bleeding, particularly of the intestines, resulting in vomiting blood or blood in the stools, or bleeding in the brain. The lymphoma team may give the patient transfusions of platelets to stop or prevent bleeding, or drugs to boost platelet numbers in the blood.

After treatments such as chemotherapy and radiotherapy, patients with non-Hodgkin's lymphoma have low numbers of white blood cells in the blood (known as neutropenia) and therefore have an increased risk of infection, often for many weeks after the treatment was given.

The patient will be regularly seen by the lymphoma team, and blood tests will be performed to see how many white blood cells are being produced by the body. However, it is important that patients are aware of the side effects of low white blood cell levels, and contact the team as soon as they start to feel ill.

If they develop a cough or a fever, in which their temperature goes above 38^oC (100.5^oF), they develop any unexplained bruising or bleeding, shivering or sweating, or they suddenly feel unwell even with a normal temperature, they should contact the hospital straight away. Especially when unsure about the nature or the duration of the fever, it's always best to call and get reassurance about how to proceed, rather than waiting.

There are some simple ways for patients to reduce their risk of infection. These include:

• Always washing hands well before preparing food
• Taking care to avoid cuts and scratches by wearing gloves for gardening or housework
• Avoiding large crowds and people with colds and flu, if possible.
• Some doctors recommend that patients do not have dental treatment during a course of chemotherapy, as this can increase the risk of mouth infection.
• Not going swimming, due to the risk of picking up an infection from the water. Patients can also pick up an infection from a crowded swimming pool or changing room
• Avoiding crowds when doing other sports or social activities
• If planning a holiday abroad, patients should check with their GP first, as some vaccines should be avoided. These include measles, mumps, rubella and MMR, oral polio vaccines, liquid typhoid, BCG, and yellow fever