Dear Dr. Roach: I have myeloma, and I’ve been treated with melphalan. On three instances, my blood count dropped from 10 to 8, requiring blood transfusion. Is the blood loss unstoppable? Is there anything I can do with diet or other medications? I’ worried about the effects of so many blood transfusions.


Dear R.T.: Multiple myeloma is a type of blood cell cancer, where plasma cells (which normally make antibodies) grow out of control; this can prevent the other cells of the bone marrow from growing normally. Low red blood cell, white blood cell and platelet cell counts all are common in people with myeloma.

Treatment for many cancers includes chemotherapy drugs. Many of these, like melphalan, work by targeting fast-growing cells. This is good for fast-growing cancer cells, but it also can damage healthy fast-growing cells like blood cells (causing anemia) or the lining of the gut (causing diarrhea and many other symptoms).

In your case, both the cancer and its treatment could be causing your low blood cell count. It’s not blood cell loss as much as it is that your body can’t replace the blood cells as they wear out normally. Those blood cells are particularly important when you are fighting off cancer, so blood transfusions often are necessary. The blood supply is very, very safe now — not perfect, but safer than it has ever been.

Some people with anemia need iron or vitamin B-12, but because your body isn’t making a lot of blood now, you probably don’t need a lot of iron or B-12. People taking chemotherapy often have nausea that limits food consumption, but I agree with most experts’ recommendations to do one’s best to eat plenty of fruits and vegetables, avoid high-fat foods from animal sources, try some new foods and try eating smaller amounts more frequently if that helps.

Dr. Roach Writes: A recent column on removing grease from the hands generated reader responses. Several wrote to include a mild abrasive, such as sugar or coffee grounds, in soap. I find that commercial products, such as GOJO or Fast Orange, work well. A wound-care specialist wrote of taking care of cuts and abrasions. Once the hands are cleaned and degreased, cuts should be bandaged. I recommend using antibiotic ointments, as they protect the wound. Never use harsh soaps or hydrogen peroxide on an open wound, as it damages the healthy regenerating tissue more than any bacteria that might be there.

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