The red cells in your blood carry oxygen to your tissues. Combination therapy causes the number of red blood cells in your body to go down. This is called anemia. Because tissue needs oxygen to work right, a decreased level can cause you to feel tired or fatigued. For those who have heart and circulation problems, anemia can become dangerous. Therefore, your healthcare provider will take blood from you, before starting the therapy, and several times after to make sure your level of red blood cells are appropriate.
Combination therapy also changes the number of platelets in your blood. Platelets make your blood sticky. This helps your blood to seal off a blood vessel when it has been cut. Platelets are like your own natural band-aid.
Combination therapy lowers the level of platelets in your blood. This means that some of your tissues, like your skin and gums, can bleed more easily if they are cut. Because there may not be enough platelets to close off the injury, the cut may not stop bleeding.
To help keep your gums from bleeding, try using a soft toothbrush. You will also need to shave with an electric razor so you don't accidentally cut yourself. You may have nosebleeds and get bruises more than usual because of the lower level of platelets. After the therapy, the amount of platelets will go back up again, and these problems should go away.