Acute Myeloid Leukemia - The Leukemia & Lymphoma Society

Low Blood Cell Counts. AML decreases the production of normal blood cells.In addition, chemotherapy is toxic to both normal blood cells and AML cells. Thenormal blood cells are eliminated from the marrow along with AML cells. For thepatient, this results in a severe deficiency in the◦{Red cells (anemia)◦{Platelets (thrombocytopenia)◦{White cells called “neutrophils” and “monocytes” (neutropenia and monocytopenia).Transfusion of red cells and platelets is almost always needed for a period ofseveral weeks during treatment. After that, the blood cell counts usually returntoward normal.Infection. During treatment for AML, the deficiency of neutrophils andmonocytes (types of white cells) can lead to infection from bacteria and funginormally present in the environment, on the skin and in the nose, mouth or colon.The risk of infection may be increased because chemotherapy damages the liningof the mouth and intestines, making it easier for bacteria to enter the blood. Whenthe white cell count is low and infection risk is increased, antibiotics are given toprevent or treat infection. Transfusion is not generally used for patients with a lowneutrophil count, but can be used in patients with high fever, infection that isunresponsive to antibiotics, blood fungal infections or septic shock.Growth factors may be given to the patient to stimulate the marrow to make newwhite cells. The growth factors used most frequently are G-CSF (granulocytecolony-stimulating factor; filgrastim [Neupogen®] and pegfilgrastim [Neulasta®])and GM-CSF (granulocyte-macrophage colony-stimulating factor; sargramostim[Leukine®]). These agents are used in children only in special circumstances.Because the patient has an increased risk of developing an infection, the medicalstaff and family and friends need to practice frequent and vigorous hand washingand take other precautions to avoid exposing patients to bacteria, viruses and otherinfection-causing agents. Caregivers for patients with central lines or ports need tobe meticulous in the cleaning of catheters.Patients at home should not delay in seeking medical attention if any signs ofinfection develop. A rise in temperature to 101°F or higher, or the onset of chills,may be the only sign of infection in a patient with a very low white cell count.Other signs of infection may include persistent coughing; tenderness at a site proneto infection, such as the area surrounding the anus or the facial sinuses; sore throat;pain on urination; or frequent loose stools.page 24 I 800.955.4572 I www.LLS.org