Effects on blood cells
This treatment can reduce the number of blood cells in your blood. You will have regular blood tests to check your blood cell levels. If the number of white blood cells, or blood-clotting cells (platelets), gets too low, your doctor may delay your treatment until the levels improve.
Risk of infection
This treatment can reduce the number of white blood cells in your blood. These cells fight infection. If the number of white blood cells is low, you are more likely to get an infection. A low white blood cell count is called neutropenia.
If you have an infection, it is important to treat it as soon as possible. Contact the hospital straight away on the 24-hour contact number you have if:
- your temperature goes over 37.5°C (99.5°F)
- you suddenly feel unwell, even with a normal temperature
- you have symptoms of an infection.
Symptoms of an infection include:
- feeling shaky
- a sore throat
- a cough
- diarrhoea
- needing to pass urine a lot.
It is important to follow any specific advice your cancer treatment team gives you.
The number of white blood cells will usually return to normal before your next treatment. You will have a blood test before having more treatment. If your white blood cell count is low, your doctor may delay your treatment for a short time.
Anaemia (low number of red blood cells)
This treatment can reduce the number of red blood cells in your blood. These cells carry oxygen around the body. If the number of red blood cells is low, you may be tired and breathless. Tell your doctor or nurse if you feel like this.
If you are very anaemic, you may need a drip to give you extra blood cells. This is called a blood transfusion.
Bruising and bleeding
This treatment can reduce the number of platelets in your blood. Platelets are cells that help the blood to clot. Tell your doctor or nurse if you have any bruising or bleeding that you can’t explain. This includes:
- nosebleeds
- bleeding gums
- tiny red or purple spots on the skin that may look like a rash.
Feeling sick
Your doctor will give you anti-sickness drugs to help prevent or control sickness. Take the drugs exactly as your nurse or pharmacist tells you. It is easier to prevent sickness than to treat it after it has started.
If you feel sick, take small sips of fluids and eat small amounts often. If you continue to feel sick, or if you vomit more than once in 24 hours, contact the hospital as soon as possible. They will give you advice and may change the anti-sickness drug to one that works better for you.
Loss of appetite
This treatment can affect your appetite. Do not worry if you don’t eat much for a day or two. But if your appetite does not come back after a few days, tell your nurse or dietitian. They will give you advice. They may give you food or drink supplements.
Raised blood sugar levels
This treatment may raise your blood sugar levels. Symptoms of raised blood sugar include:
- feeling thirsty
- needing to pass urine more often
- feeling tired.
Tell your doctor or nurse if you have these symptoms. If you have diabetes, your blood sugar levels may be higher than usual. Your doctor will talk to you about how to manage this.
Diarrhoea or constipation
You may have diarrhoea or tummy pain. Some people become constipated, but this is less common. Your doctor can give you drugs to help. If you are also having chemotherapy, diarrhoea may be more severe. Follow any instructions the hospital give you. If you have diarrhoea or constipation, make sure you drink at least two litres (three and a half pints) of fluids every day.
Skin changes
Rituximab may cause a rash, which can be itchy. You may also notice unusual feelings in your skin such as numbness, tingling, pricking or burning. Rarely, skin reactions can be more severe. Tell your doctor or nurse about any skin changes. They can give you advice and may prescribe creams or medicines to help. Any changes to your skin are usually temporary and improve when treatment finishes. We have more information about caring for skin and nails.
Muscle and/or joint pain
You may get pain in your joints or muscles. Tell your doctor if this happens so they can give you painkillers. Let them know if the pain does not get better. Having warm baths and taking regular rests may help.
Eye problems
This treatment may make your eyes feel sore, red and itchy (conjunctivitis). Your doctor will prescribe eye drops to help. It is important to use these as instructed.
Always tell your doctor or nurse if you have pain or notice any change in your vision.
Effects on the nervous system
Rituximab can affect the nervous system. You may feel anxious or restless, have problems sleeping or feel dizzy. Tell your doctor or nurse straight away if you notice any of these symptoms.
It is important not to drive or operate machinery if you notice these effects.
Effects on the lungs
This treatment can cause changes to the lungs. Tell your doctor if you develop:
- a cough
- wheezing
- a fever (high temperature)
- breathlessness.
You should also tell them if any existing breathing problems get worse. You may have tests to check your lungs.