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Nadir period

  • Writer: Mayta
    Mayta
  • Jan 23, 2024
  • 2 min read

The nadir period in chemotherapy is indeed a critical phase where patients are at the highest risk for neutropenia, a condition where there is a low level of neutrophils, a type of white blood cell vital for fighting infection. This period generally occurs around 10 to 14 days after a chemotherapy cycle, but this can vary depending on the specific drugs used.

During this time, it's essential to monitor and manage blood counts vigilantly:

  1. Red Blood Cells (RBC) and Hemoglobin (Hb):

  • Aim to maintain hemoglobin levels above 7 g/dL.

  • Blood transfusions or erythropoiesis-stimulating agents (like epoetin alfa) might be used in cases of significant anemia.

  1. Platelets (Plt):

  • The general threshold for prophylactic platelet transfusion is a count below 10,000/μL in stable, non-bleeding patients.

  • In the context of fever or active bleeding, the threshold for transfusion is higher, typically around 20,000/μL.

  1. Febrile Neutropenia:

Criteria

  • Febrile neutropenia, defined as a single oral temperature measurement of ≥38.3°C (101°F) or a temperature of ≥38.0°C (100.4°F) sustained over 1 hour in the context of neutropenia, is a medical emergency.

  • Prompt evaluation and initiation of broad-spectrum antibiotics are crucial.

  • Cultures should be obtained before starting antibiotics, and the patient should be closely monitored for signs of sepsis or other complications.

Preventative measures during this period are essential. These include good hygiene practices, avoiding crowds or individuals with infections, and potentially prophylactic antibiotics or antifungals in high-risk scenarios. It's also crucial for patients to be aware of the signs and symptoms of infection and when to seek immediate medical attention.

These guidelines are aligned with standard oncological practices and aim to mitigate the risks associated with chemotherapy-induced myelosuppression. However, individual patient management may vary based on the specific chemotherapy regimen, the patient's overall health, and other risk factors.


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Post: Blog2_Post

Message for International Readers
Understanding My Medical Context in Thailand

By Uniqcret, M.D.
 

Dear readers,
 

My name is Uniqcret, which is my pen name used in all my medical writings. I am a Doctor of Medicine trained and currently practicing in Thailand, a developing country in Southeast Asia.
 

The medical training environment in Thailand is vastly different from that of Western countries. Our education system heavily emphasizes rote memorization—those who excel are often seen as "walking encyclopedias." Unfortunately, those who question, critically analyze, or solve problems efficiently may sometimes be overlooked, despite having exceptional clinical thinking skills.
 

One key difference is in patient access. In Thailand, patients can walk directly into tertiary care centers without going through a referral system or primary care gatekeeping. This creates an intense clinical workload for doctors and trainees alike. From the age of 20, I was already seeing real patients, performing procedures, and assisting in operations—not in simulations, but in live clinical situations. Long work hours, sometimes exceeding 48 hours without sleep, are considered normal for young doctors here.
 

Many of the insights I share are based on first-hand experiences, feedback from attending physicians, and real clinical practice. In our culture, teaching often involves intense feedback—what we call "โดนซอย" (being sliced). While this may seem harsh, it pushes us to grow stronger, think faster, and become more capable under pressure. You could say our motto is “no pain, no gain.”
 

Please be aware that while my articles may contain clinically accurate insights, they are not always suitable as direct references for academic papers, as some content is generated through AI support based on my knowledge and clinical exposure. If you wish to use the content for academic or clinical reference, I strongly recommend cross-verifying it with high-quality sources or databases. You may even copy sections of my articles into AI tools or search engines to find original sources for further reading.
 

I believe that my knowledge—built from real clinical experience in a high-intensity, under-resourced healthcare system—can offer valuable perspectives that are hard to find in textbooks. Whether you're a student, clinician, or educator, I hope my content adds insight and value to your journey.
 

With respect and solidarity,

Uniqcret, M.D.

Physician | Educator | Writer
Thailand

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