While it is relatively rare, bleeding can be a side effect of chemotherapy or radiation, a result of the cancer itself, the result of an allergic reaction to some medications (especially quinidine, quinine, digitalis, sulfonamides, or thiazides), or caused by stress and anxiety. Bleeding may occur directly from the skin or may arise from the mouth, nose, groin, or elsewhere.

<b> Practical Strategies</b>

To prevent bleeding, be sure the patient:

<ul>

<li>  Avoids activities that might be too physically strenuous and that may cause even minor trauma</li>

<li> Avoids hand razors, cuticle scissors, tight-fitting clothes that could irritate the skin, tourniquets, and aspirin</li>

<li>  Avoids strenuous activities, such as lifting, bending over from the waist, or straining during a bowel movement</li>

<li>  Drinks plenty of liquids to keep the mucous membranes moist</li>

<li> Follows hygienic precautions listed under "Mouth or Throat Sores," earlier in this chapter, to avoid mouth bleeding</li>

<li> Keeps stools soft and avoids using anything in the rectum (thermometers, enemas) to prevent bleeding from the anus</li>

<li> Takes an antacid or milk with oral steroids to prevent irritating the stomach</li>

<li> Uses a lubricant before sexual intercourse (for women) to prevent friction and bleeding; avoids douches and vaginal suppositories</li>

<li> Blows nose very gently through both nostrils and keeps air humid with a vaporizer or humidifier to avoid bleeding from the lungs or nose</li>

</ul>

If bleeding occurs, apply pressure to the area for five to ten minutes, and if a limb is involved, elevate it. Apply ice to cause the local blood vessels to constrict. If the nose bleeds, squeeze the nostrils gently shut below the bridge of the nose; tilt the head forward to prevent blood from backing up. If it persists, place an ice pack on the bridge of the nose. Contact the doctor if bleeding of any kind doesn't stop after five minutes.