Myelosuppression is a common anti-cancer drug*** It is the cytotoxicity of the drug that inhibits the hematopoietic function of the human bone marrow, resulting in the symptoms of pancytopenia. The occurrence of myelosuppression not only affects the patient's health status and progress, but also leads to serious complications and even life-threatening. Therefore, it is necessary to understand the relevant knowledge of bone marrow suppression.
So what are the anticancer drugs that tend to cause bone marrow suppression?When myelosuppression occurs, how should I care for it?
Drugs that predispose to bone marrow suppression.
Clinically, most of the antineoplastic drugs used during cancer** have a certain degree of cytotoxicity, which triggers varying degrees of myelosuppression. Among them, the drugs that are more likely to trigger bone marrow suppression are the following:
1.Alkylating agents: nitrogen mustards (nitrogen mustard hydrochloride, melphalan), nitrosoureas (nimustine, carmustine, lomustine, semustine, formomustine), others (ciotepa, busulfan);
2.Antimetabolites: methotrexate, fluorouracil, cytarabine, fludarabine, and mercaptopurine;
3.Antineoplastic antibiotics: anthracyclines (doxorubicin, alorubicin, epirubicin, pirarubicin, daunorubicin), actinomycin D, and mitomycin;
4.Antitumor botanicals: vinblastine, vinorelbine, paclitaxel, docetaxel, harringtonine, topotecan, irinotecan, etoposide and teniposide;
5.Platinum: carboplatin, cisplatin.
Which patients are more likely to have myelosuppression?
In addition to drug factors, the patient's physical condition and disease status are also factors that may increase the risk of myelosuppression. Patients with the following risk factors are more alarmed for myelosuppression
Age 65 years;
Female;Patients with poor performance status (performance status score 2 points);
Patients who have had myelosuppression in the past**;
Patients with open wounds or recent surgery, or patients with co-infection;
Patients with tumor tissue invasion of bone marrow;
Patients who have had prior chemoradiotherapy;
Patients with liver, kidney, cardiac insufficiency and other organ dysfunction;
Patients who have been using immunosuppressants (such as glucocorticoids) for a long time, such as patients who have undergone transplantation or have autoimmune diseases.
Daily care of the patient during chemotherapy.
1.Prevent infection.
During chemotherapy, patients should maintain personal hygiene, clean and ventilate the room regularly, avoid crowds as much as possible, and wear masks when going out.
2.Enhance nutrition.
Keep the diet nutritious, light and easy to digest, choose foods that are high in calories, high in protein, and high in vitamins, eat small, frequent meals, and increase your overall intake. Prioritize high-quality protein, increase the intake of fresh vegetables and fruits, and eat more iron-rich foods to maintain nutritional balance.
3.Appropriate activities.
Arrange appropriate activities according to the patient's physical condition, such as walking, tai chi, etc.
4.Oral care.
Drink plenty of water every day to promote drug metabolism, rinse your mouth or brush your teeth after meals, and keep your mouth moist and clean.
5.Do a good job of monitoring.
During chemotherapy, check the blood routine regularly (1 or 2 times a week), and if the blood routine is abnormal, you should see a doctor in timePay attention to monitoring the patient's status and detect signs of infection in time;Observe whether there are petechiae, ecchymosis and other bleeding phenomena in the mucosa;Observe whether there are ulcers and erosions in the oral mucosa, whether there is bleeding gums, etc.;Pay attention to the nature and color of the stool, and be alert to gastrointestinal bleeding.
Key points of care for leukopenia.
1.Keep the room environment clean
The patient's room should be ventilated with windows open every day to keep the air fresh and tidyThe indoor floor and surface of items should be disinfected and cleaned regularly, and items should be placed as little as possibleWhen the patient has granulocytes 1At 0 10 9 l, the patient should be isolated and protected in time.
2.Prevent infection.
Avoid unnecessary visits and visits, and reduce human contact;Do not come into contact with people with respiratory infections to prevent cross-infection;Reduce going out and wearing a mask when entering and leaving the hospital;Strengthen food safety, do not eat raw and cold food, and fruits are best steamed and eaten;Pay attention to oral, perineal and perianal hygiene.
3.Medications**
According to the doctor's instructions, whitening drugs are commonly used to include muscles, joint soreness, etc., patients need to rest in bed, reduce activities, and take painkillers if the pain is severe.
Key points of care for thrombocytopenia.
1.Prevent bleeding
Patients should avoid unnecessary activities and, if necessary, stay absolutely in bed to avoid bumpsDo not scratch too hard **, nasal passages;Brush your teeth with a soft-bristled toothbrush to avoid bleeding gumsAvoid eating rough, chunky, hard foods to prevent bleeding from the digestive tract;Keep your stool smooth and avoid straining to have a bowel movementPatients with nausea and vomiting should be treated with antinausea** and avoid sudden sitting.
2.Platelet-raising drugs**
Follow the doctor's instructions to raise platelets**, observe the patient's reaction after medication, and inform the doctor in time if you feel unwell.
3.Observe closely
Thrombocytopenia may cause severe bleeding symptoms and endanger the patient's life, so it is necessary to closely observe the patient's vital signs and changes in the condition, and pay attention to the bleeding tendency, including the patient's urine and stool color;**Whether there are ecchymoses and petechiae on the mucous membrane, and whether there is bleeding in the nasal cavity and gumsIf there are symptoms such as headache, dizziness, blurred vision, projectile vomiting, shortness of breath, coma, etc., inform the doctor in time if there is any abnormality.
Key points of care for decreased red blood cells and hemoglobin.
1.Fortify your diet
Maintain a high-protein, high-calorie, high-vitamin diet and increase nutrient intakeIf it is iron deficiency anemia, you should eat more iron-rich foods, such as animal liver, animal blood, lean meat, egg yolk, kelp, fungus, etc., and avoid foods that affect iron absorption, such as strong tea, coffee, milk, etc.
2.Get plenty of rest
Patients should rest and be active if they have only mild anemia. Pay attention to safety in daily activities to prevent falls, bumps, etc.
3.Rise red**
Follow the doctor's instructions to raise the red**, use recombinant human erythropoietin (EPO) or blood transfusion** according to the degree of anemia, observe the reaction after medication, and inform the doctor in time if there is any discomfort.
4.Observe closely
Observe the patient's appearance, face and mucous membranes, and inform the doctor in time if the patient has symptoms such as fatigue, dizziness, palpitations, chest tightness, shortness of breath, and bleeding.