Supportive Care


In addition to your main therapies (chemo, radiation, surgery, BMT), you will have some treatments that are generally referred to as supportive care. They include:

  • Blood Transfusions
  • Antibiotics
  • Supplemental Nutrition

Blood Transfusions

redcross321Blood for transfusions Throughout your treatment, you are likely to need blood transfusions for two primary reasons:

  1. Your cancer is affecting your bone marrow’s ability to produce blood normally (leukemia, as an example).
  2. Your treatment – chemo and/or radiation – is destroying your healthy blood cells as well as the cancer cells.

In either case, your blood counts are too low and you may need additional blood products to keep you going.

Let’s talk about donated blood…

If you need a transfusion, the blood you receive will usually come from a local blood bank (like the Red Cross) where people donate their blood for others, like you, who need this life-saving treatment.redcross46

Very strict guidelines about blood donation, preparation, and storage have drastically reduced the risks with receiving donated blood. Donors are carefully screened before they donate and then their blood is tested to ensure that it does not contain any diseases. You may worry about getting AIDS or other diseases from a blood transfusion. That’s understandable, but put your mind to rest – the risk is almost non-existent.

What’s a transfusion like?

Typically you will need either red blood cells or platelets. Only on very rare occasions – if you have a serious infection and are not responding to antibiotics – will you receive white blood cells.

Before you receive a transfusion, a sample of your blood is tested to be sure that the blood you receive is compatible with yours. You will probably receive some medications before the transfusion (like Tylenol and Benedryl) to prevent any possible reactions.

If you have a central line, the blood will be transfused right through it. If not, you will need to have an IV started. Plan on bringing a good book or a pillow if you need red blood because it takes a while – 2-4 hours for one unit of red cells. Platelets are much quicker – only about 20 -30 minutes per bag.

redcross29Transfusion Bags of red cells are usually connected to an IV pump to keep a steady flow during the transfusion. Platelet bags are usually just hung and allowed to drip by gravity. Because platelets are very delicate cells with a much shorter life than red cells, it is best to transfuse them as quickly as possible. Nurses have been known to hang bags of platelets from the ceiling to get them in as fast as possible!

Are there any side effects?

When you receive a red blood or platelet transfusion, the white cells are filtered from the donated blood. However, even after being filtered, a few white cells might remain. If you have a reaction to the transfusion, these white cells are probably responsible.

Transfusion reactions can include:

  • Fever and chills
  • Rash
  • Hot flushes

Be sure to let someone on your medical team know if you start to feel any of these side effects.

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Antibiotic Therapy

Get used to this equation: Neutropenia + Fever = Antibiotics

When your counts are low during treatment, fevers are taken very seriously. If your temperature is higher than 100.5 F or 38 C, you must call your doctor. It will seem like a pain sometimes, especially if you have something else planned, but your life could depend on it. Really!

Don’t take any chances. When your white count is low, infections can quickly get out of control and your body has no means to defend itself.

When you spike a fever while neutropenic, you will be put on antibiotics which are given either IV or orally. You may need to be admitted to the hospital for a few days, as a precaution, until blood cultures are negative.

You may also have to take routine antibiotics to prevent possible infection, particularly pneumocystis pneumonia (PCP). This lung infection is very serious if it develops. The antibiotic you’ll probably take is called Bactrim or Septra.

Nutrition

While you are going through treatment, there may be times when you either don’t feel like eating or are just not able. During chemotherapy, as an example, you may develop mouth sores that make eating really tough. Chemo also does pretty nasty things to the inside of your gut and you may not have a normal appetite.

Lots of things – treatment, infections, fevers, the general “blahs” – sometimes make eating difficult. But it is important that you stay nourished so you can keep fighting this darn disease. Your body needs nutrition to heal just like a car needs gas to run!

When your eating patterns are disrupted, you may be put on some form of extra nutrition. These might include:

  • Hyperalimentation

    Hyper-Al or TPN (total parenteral nutrition)

    A method of intravenous nutrition consisting of carbohydrates, protein, minerals and fats to provide basic nutrition when you aren’t able to eat by mouth. This usually looks like a bag of yellow and/or milky fluid and goes in through your central line.

  • Feeding Tubes

    Naso-gastric (NG) or feeding tubes are also used to provide nutrition to your gut when you aren’t able to eat by mouth. A very small plastic tube is inserted by a nurse from your nose to your stomach so liquid nutrition can be given. This isn’t as horrible as it sounds at first, and is a very safe way to keep you strong when you can’t get enough calories or protein in your regular diet.

  • Nutritional Supplements

    There are many different kinds of supplements out there – start taste-testing a few to find one you like! (Adding these to your diet may prevent you from needing TPN or NG tubes.) Some examples are: Ensure/Pediasure, Mighty Shakes, Enlive juice boxes, Carnation Instant Breakfast, Scandi Shakes. If you feel adventurous – try your own unique recipe by adding ice cream, fruit, etc. to these in a blender!

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