Chemotherapy is a double-edged sword, killing thousands of enemies and losing 800 self, but it is a "required course" for cancer patients. In chemotherapy, the first adverse reaction is the decline of white blood cell level, which is very common.
Some chemotherapy regimens are indeed harmful to bone marrow, especially carboplatin, paclitaxel, docetaxel and other drugs. In this case, how to prevent the use of Shengbai needle has become a big problem.
1、 How to judge whether white blood cells are reduced?
• leukopenia: peripheral blood leukocyte count is lower than the lower limit of normal value.
• neutropenia: the absolute value of neutrophils in peripheral blood is less than 2.0*109/l.
• febrile neutropenia: the axillary temperature is greater than 38.1 ℃, or the axillary temperature measured twice in two hours is greater than 37.8 ℃, and the neutrophils are less than 0.5*109/l.
2、 What is the change process of leukocytes during chemotherapy?
Chemotherapy drugs can inhibit the hematopoietic function of bone marrow, resulting in the reduction of neutrophils. Generally, neutrophils begin to decline one week after chemotherapy, reach the lowest point on the 10th to 14th days, and gradually return to normal on the 21st to 28th days.
3、 What are the symptoms of leukopenia patients?
• patients with leukopenia usually have no obvious clinical symptoms, and some patients will have dizziness, fatigue, anorexia, depression, low fever and other non characteristic manifestations.
• patients with significantly reduced leukocytes may suddenly develop symptoms such as chills, high fever, sweating, and severe infection within 2 to 3 days.
4、 White needles can also be injected in advance!
The purpose of Shengbai needle is to shorten the duration of leucopenia, return the leucocyte value to normal as soon as possible, and reduce the infection caused by low leucocyte value.
From the perspective of chemotherapy regimen:
In patients who use high-intensity regimen, if leucopenia occurs after chemotherapy, it is expected that the duration of bone marrow suppression will be long (7 days or more) and the degree will be heavy (granulocyte deficiency, neutrophils less than 0.5 × 109/l), the patient's infection risk increases, so it is necessary to give white needle in time, even prophylactically, to shorten the duration of granulocyte deficiency, reduce the degree of bone marrow suppression, and reduce the risk of infection.
From the perspective of patients:
Some elderly and infirm patients, patients with chronic heart, lung, liver, kidney diseases and diabetes, have poor compensatory ability, and once infected, they are likely to be life-threatening.
In this case, due to the poor tolerance of patients themselves, in order to prevent infection, white needles can be given before chemotherapy, so that patients can spend the period of leucopenia after chemotherapy as soon as possible, reducing the risk of infection.
From the perspective of past treatment history:
For patients with multiple previous chemotherapy or radiotherapy, or patients with disease infiltrating bone marrow, their bone marrow compensation ability is poor, and the preventive application of Shengbai needle should also be considered before chemotherapy.
For patients with postoperative or open wounds, as well as those with heart, lung, liver, kidney and other basic diseases, or are prone to infection, or the risk of complications after infection is high, these patients also need to consider the preventive application of Shengbai needle.
In the above cases, the use of Shengbai needle is very necessary. However, we should also pay attention to the cautious use of Shengbai needle. If the intensity of chemotherapy drugs is weak, white blood cells do not drop much, or the patient has no complications, even if there is infection, it is very sure that it can be controlled. If white blood cells decrease in such patients after chemotherapy, close observation is also feasible. Most patients can gradually return to normal level after 14-21 days.
5、 When do I get the white needle?
It is recommended that the use time of L white needle should not be less than 3 days. It is also necessary to closely monitor blood routine in the process of raising white needles to avoid leukemoid phenomenon caused by excessive hematopoiesis. Generally, white blood cells >10*109/l can be used.
It is not recommended to inject white needles on the day after chemotherapy, and it is not recommended to inject chemotherapy on the day after injection. The interval between the two is better than 24 hours. This is mainly to prevent neutrophils stimulated by white needles from being damaged by chemotherapy drugs, aggravate the damage of chemotherapy to bone marrow reserve function, and increase the risk of bone marrow suppression.
6、 Precautions
1. Recheck blood routine in time and adjust the treatment plan
Generally speaking, chemotherapy can be given after the blood test is normal 24 hours after whitening. After 24 hours after the end of the first chemotherapy, routine prevention of leukocyte rise should be carried out for 3 days, and then the blood routine should be rechecked. According to the recheck results, it is considered to continue leukocyte rise or recheck the blood routine after a week.
If after the first cycle of chemotherapy, after the prevention of leukocyte rise, and before the second cycle of chemotherapy, the blood routine examination or grade IV bone marrow suppression, then the subsequent chemotherapy should be administered according to 75% of the original dose.
If there is agranulocytosis fever, it is necessary to prevent leukopenia before the next cycle and then give chemotherapy.
2. Carefully and carefully fill in the discharge records and precautions of patients
The precautions for discharge shall be clearly written, which day to start the white blood cell rise, how many days to rise, and which day to have a blood test, and the patient shall report the results to the doctor in time.
If you just say orally when to begin to increase leukocytes, the patient's compliance is very poor, and it will be too late for grade IV myelosuppression to occur. In addition, the discharge summary must indicate the discomfort follow-up.
Next, we will summarize the drugs that promote leukocyte production, which mainly include traditional leukocyte enhancing drugs such as ricodin, vitamin B4, shark liver alcohol, biological products such as granulocyte colony stimulating factor (G-CSF), granulocyte macrophage colony stimulating factor (GM-CSF) and other drugs.
Traditional leucocyte raising drugs
Biological products
Other drugs
Reference link:
https://www.medsci.cn/article/show_article.do?id=f902e3331500
