Neutropenia is a low number of neutrophils, a type of white blood cell. Neutrophils play an important role in preventing infection throughout the body, so having an abnormally low number of neutrophils increases the risk of infection. Neutropenia also makes it more difficult for an infection to resolve if bacteria do enter the body. The lower the neutrophil count, the greater the risk for infection. It is important to note, however, that most people treated for cancer have neutropenia but do not get an infection.

Why does neutropenia occur?

White blood cells divide and grow rapidly and may therefore be damaged by chemotherapy, radiation therapy or immunotherapy. Many factors contribute to the development of neutropenia, including the dose and type of chemotherapy or radiation therapy and the overall health of an individual.

Who is most likely to be affected by neutropenia?

Neutropenia is most likely to occur in people who are receiving a combination of radiation therapy and chemotherapy. It is also common among people who are treated with either of these two treatments alone. People who receive a bone marrow transplant are also likely to be affected by neutropenia.

When does neutropenia occur?

The neutrophil count usually starts to drop about seven days after a treatment cycle and reaches the lowest point (called the nadir) between seven and 14 days after treatment. The count will begin to rise again and may take three to four weeks to return to normal. The neutrophil count must be normal in order for you to receive the next treatment.

How is neutropenia managed?

Neutropenia is an expected side effect and cannot be prevented. Because of this, it is important to take steps to reduce your risk of getting an infection. Studies have shown that the most effective way to prevent infection is frequent handwashing, but you can also take several other preventive steps (Table 1).

During cancer treatment, your white blood cell count will be checked often so that precautions or treatment can be started if appropriate. If the neutrophil count is extremely low, your doctor may delay your next treatment until the count has increased. For the time that the count is low, your doctor will have you follow “neutropenic precautions,” or extra measures to prevent infection. These precautions include:

Taking your temperature four times each day
Not eating uncooked foods
Staying away from fresh flowers, plants and gardening
Avoiding enemas, rectal suppositories, and rectal thermometers
Not having dental work

Some people with an extremely low neutrophil count may benefit from treatment with a growth factor. These growth factors are special proteins that can stimulate the bone marrow to produce more white blood cells and are usually given as an injection under the skin (subcutaneously). The growth factors used most often are pegfilgrastim (Neulasta) and filgrastim (Neupogen).

Table 1. Ways to prevent infection

Use excellent personal hygiene	▪ Wash your hands frequently, especially before eating and after using the bathroom ▪ Do not cut or pick at cuticles (use a cuticle cream) ▪ Brush teeth after each meal and at bedtime ▪ Use alcohol-free, antiseptic mouthwash daily ▪ Use a deodorant rather than an antiperspirant ▪ Use a water-soluble lubricant during sexual intercourse and perform good hygiene immediately following intercourse
Avoid situations that could increase the risk of infection	▪ Avoid people with colds or other infections (and people who live with others who have a cold or infection) ▪ Avoid contact with anyone who has recently been vaccinated, including infants and children ▪ Avoid crowds as much as possible (when necessary, go out at off-peak times) ▪ Avoid public transportation (when necessary, use during off-peak times) ▪ Do not handle animal waste (including cat litter and fish tank water)
Use extra precaution to reduce the chance of injury	▪ Always wear shoes ▪ Protect your hands (wear gloves when doing dishes or gardening) ▪ Prevent constipation ▪ Wear sunscreen with a sun protection factor (SPF) of at least 15 ▪ Use an electric razor rather than a blade razor ▪ Do not receive any vaccination, including the flu vaccine (ask your oncologist about the flu vaccine)

When should I talk to my doctor about neutropenia?

You should talk to your doctor or nurse about the possibility of neutropenia with your specific treatment.

Call your doctor’s office immediately if you have signs of infection, which include:

Fever (oral temperature over 100.5 F), chills and sweating
Flu-like symptoms (body aches, general fatigue) with or without fever
Cough, shortness of breath, painful breathing
Sore throat or sores in your mouth
Redness, pain or swelling on any area of your skin
Pus or drainage from any open cut or sore
Diarrhea (loose or liquid stools)
Pain or burning with urination
Vaginal drainage or itching

Neutropenia

Learn to manage higher risk of infection