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When chemotherapy lowers the platelets that help blood clot, small changes at home lower the chance of bleeding: a very soft toothbrush, an electric shaver, shoes on, no aspirin or ibuprofen unless the team agrees, and firm pressure on any cut. Some signs need a call to the team straight away, such as bleeding that will not stop, blood in urine or stools, or a bad headache or change in vision.
The home advice comes from national patient guidance: NCI's Chemotherapy and You (2023) and its thrombocytopenia page (reviewed 2022), and Macmillan (2018, under review). They agree on a very soft toothbrush, an electric shaver, care with sharp objects, shoes at all times, gentle nose-blowing, avoiding aspirin, ibuprofen and supplements without the team's agreement, firm pressure on bleeding, treating constipation, and calling about named warning signs. They differ on flossing: NCI's booklet says not to use dental floss but suggests a water flosser, its mouth-care section says to ask before flossing, and Macmillan says not to floss. None of this has been tested in a trial and none of it is graded. Platelet support is a clinical decision: NICE NG24 offers prophylactic platelet transfusion below 10 x 10^9 per litre to people who are not bleeding and not having a procedure, with exceptions (chronic bone marrow failure, autoimmune thrombocytopenia, HIT, TTP), and transfusion for clinically significant bleeding below 30 x 10^9 per litre. ASCO 2018 allows adults after autologous stem cell transplant at experienced centres to be transfused at the first sign of bleeding rather than prophylactically.
Why: Gums bleed easily when platelets are low; a soft brush cleans without cutting them.
“Brush your teeth with a very soft toothbrush.”
National Cancer Institute (US) 2023 · Not graded (patient booklet)
Why: Small cuts bleed for longer when platelets are low.
“Use an electric shaver instead of a razor.”
National Cancer Institute (US) 2023 · Not graded (patient booklet)
Why: Knocks and falls cause bruising and bleeding that may be hard to stop.
“Wear shoes all the time, even inside the house or hospital.”
National Cancer Institute (US) 2023 · Not graded (patient booklet)
Why: These can damage delicate linings and cause bleeding. NCI lists them under 'Things not to do'.
“Use tampons, enemas, suppositories, or rectal thermometers.”
National Cancer Institute (US) 2023 · Not graded (patient booklet; listed under 'Things not to do')
Why: Aspirin and ibuprofen make bleeding more likely, and some supplements change how treatment works.
“Many over-the-counter medicines contain aspirin or ibuprofen, which can increase your risk of bleeding.”
National Cancer Institute (US) 2022 · Not graded (patient information)
Why: Straining can make the back passage bleed.
“They may prescribe a stool softener to prevent straining and rectal bleeding when you go to the bathroom.”
National Cancer Institute (US) 2023 · Not graded (patient booklet)
Why: Steady pressure helps a clot form when there are fewer platelets to make one.
“If you start to bleed, press down firmly on the area with a clean cloth. Keep pressing until the bleeding stops.”
National Cancer Institute (US) 2022 · Not graded (patient information)
Why: These can be signs of serious bleeding, including bleeding in the brain, and need checking the same day.
“Head or vision changes such as bad headaches or changes in how well you see, or if you feel confused or very sleepy.”
National Cancer Institute (US) 2022 · Not graded (patient information)
Why: A platelet transfusion or a treatment delay is the team's decision, made on the count and on whether there is bleeding.
“You may need medication, a platelet transfusion, or a delay in your chemotherapy treatment if your platelet count is too low.”
National Cancer Institute (US) 2023 · Not graded (patient booklet)
How care is usually carried out, read from the guidelines and standards cited. Your own team's protocol and their judgement come first; this page is for understanding it, not for doing it yourself.
No guideline grades home bleeding precautions; the best available version is the national patient guidance from NCI (2023 booklet, 2022 web page), with Macmillan (2018) agreeing on every point except flossing. Where they differ, NCI's booklet allows a water flosser but not dental floss, and Macmillan says not to floss. The clinical side is graded by its own guidelines: NICE NG24 (2015, updated 2026) offers prophylactic platelet transfusion below 10 x 10^9 per litre to people who are not bleeding or having a procedure, and transfusion for clinically significant bleeding below 30 x 10^9 per litre; ASCO 2018 agrees on prophylactic thresholds and allows transfusion at the first sign of bleeding, rather than prophylactically, for adults after autologous stem cell transplant at experienced centres.
National Cancer Institute (US) 2023 · National Cancer Institute (US) 2022 · Macmillan Cancer Support 2018 · NICE 2015 · ASCO (Journal of Clinical Oncology) 2018
Where it differs: Says to use a soft toothbrush and not to floss, with no mention of a water flosser.
Evidence: Patient information, not graded: 'Use a soft toothbrush to protect your gums from bleeding and do not floss.' NCI's booklet instead suggests a water flosser and, in its mouth-care section, says to ask about flossing when platelets are low.
Macmillan Cancer Support 2018 · National Cancer Institute (US) 2023
Where it differs: Adds protective gloves for household and garden work to prevent cuts.
Evidence: Patient information, not graded: 'Wear protective gloves when doing work around the house or in the garden.'
Where it differs: Adults after autologous stem cell transplant at experienced centres are transfused at the first sign of bleeding rather than at a set count.
Evidence: ASCO 2018, from randomised trials, as stated in the abstract; prophylactic thresholds still apply to children after autologous transplant and to everyone after allogeneic transplant.
| Recommendation | Grade, as printed | Source |
|---|---|---|
| Home bleeding precautions | Not graded: patient booklets and web pages give expert advice without a grading scheme | National Cancer Institute (US) 2023 |
| Prophylactic platelet transfusion below 10 x 10^9 per litre for people who are not bleeding or having a procedure, except in chronic bone marrow failure, autoimmune thrombocytopenia, HIT and TTP | Not graded (NICE NG24 1.7.3, 'offer'); the threshold's superscript does not survive in the page text, so it is given here in prose | NICE 2015 |
| No routine prophylactic platelet transfusion in chronic bone marrow failure, autoimmune thrombocytopenia, HIT or TTP “Do not routinely offer prophylactic platelet transfusions to people with any of the following:” | Not graded (NICE NG24 1.7.7) | NICE 2015 |
| No prophylactic platelet transfusion before low-bleeding-risk procedures such as central venous cannulation “Do not offer prophylactic platelet transfusions to people having procedures with a low risk of bleeding, such as adults having central venous cannulation or any people having bone marrow aspiration and trephine biopsy.” | Not graded (NICE NG24 1.7.8, 'do not offer') | NICE 2015 |
| Adults after autologous stem cell transplant may be transfused at the first sign of bleeding “Based on data from randomized controlled trials, adult patients who undergo autologous stem-cell transplantation at experienced centers may receive a platelet transfusion at the first sign of bleeding, rather than prophylactically.” | Based on randomised controlled trials (as stated in the ASCO 2018 abstract; the graded recommendation table was not read) | ASCO (Journal of Clinical Oncology) 2018 |