When chemotherapy is given to cancer patient, it affects both the cancer and the normal cells of the body. The cells of the body that divide are affected in particular and these can be cells of the hair, lining of the mouth, lining of the intestines and blood cells.

Blood cells are made in the bone marrow of our bones. Initially the cells start out as stem cells and it is from these immature cells that all the different types of blood cells develop. The stem cells do not divide fast and are less likely to be affected by the chemotherapy drug. However, as they mature, the blood cells pass through different phases where they tend to divide very fast. It is in these phases that the cells are affected. These cells continue to mature for a couple of days after chemotherapy is given and then they start to die. As a result the blood count falls to a low point as there are not enough cells maturing to keep up with the depletion. This low point is known as nadir.

However, it is important to know that the blood count invariably returns to normal within 3 to 4 weeks. This usually happens when the body sends a signal to the bone marrow to increase production of stem cells. Doctors do not give chemotherapy drugs when the bone marrow is in the process of increasing the production of stem cells as this can cause permanent damage to the marrow.

Usually a patient will experience nadir 10 days after the chemotherapy but this can change depending on the type of drug being given. Nadir is sensitive time and doctors watch over the patient carefully as he is very susceptible to infections and bleeding due to extremely low white blood cell and platelet counts. The next session of chemotherapy is usually scheduled after the blood count has left nadir.

This clearly shows that nadir and chemotherapy are interlinked and one has to take this into account when undergoing chemotherapy.

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