Neutropenia
Neutropenia is a condition in which you have 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 them increases your risk of infection and makes it more difficult for an infection to resolve. Most people who are treated for cancer with some types of radiation therapy and chemotherapy have neutropenia but do not get an infection.
What causes neutropenia?
White blood cells divide and grow rapidly, making them vulnerable to damage from cancer treatments. Treatments that typically affect neutrophils include chemotherapy, radiation therapy, bone marrow/stem cell transplantation, immunotherapy and steroids. The dose and type of the therapy and the overall health of an individual contribute to the development of neutropenia. Combination therapies tend to increase the risk.
When does neutropenia typically occur?
The neutrophil count usually starts to drop about 7 days after a treatment begins and reaches the lowest point between 7 and 14 days after treatment. During treatment, your health care provider will order blood tests frequently to check your absolute neutrophil count (ANC). It must be at a certain level for it to be safe to have your next scheduled treatment. Generally, the count rises again on its own. If the neutrophil count is extremely low and you hear that you are “neutropenic,” your health care provider may delay your next treatment until the count has increased. For the time that the count is low, you may be instructed to follow these neutropenic precautions:
- Take your temperature 4 times each day, or as advised by your health care provider.
- Don't eat uncooked foods.
- Avoid fresh flowers, plants and gardening.
- Avoiding using enemas, rectal suppositories and rectal thermometers.
- Postpone dental work.
Your health care provider may prescribe preventive antibiotics and/or growth factors. 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).
How you can manage neutropenia
Although neutropenia cannot be prevented, you can take steps to help reduce your risk of infection:
- Stay current with your vaccinations, and avoid anyone, including infants and young children, who were vaccinated recently.
- Wash your hands frequently. 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 deodorant instead of antiperspirant.
- Use a water-soluble lubricant during sexual intercourse, and perform good hygiene immediately following intercourse.
- Avoid people with colds or other infections, such as COVID-19, influenza and RSV, and people who live with others who have these and other infections. Also avoid young children who may appear healthy but could be harboring colds, flu, chickenpox or other contagious ailments.
- Limit being around crowds and on public transportation if possible. When necessary, go at off-peak times and wear a medical-grade mask. Ask a caregiver or friend to do the errands that you do not have to do yourself and to dispose of animal waste (including cat litter and fish tank water).
- Reduce risk of injury by wearing shoes, protecting your hands when doing dishes or gardening, preventing constipation, wearing sunscreen with a sun protection factor (SPF) of at least 15 and using an electric razor.
When to call your health care provider.
Infections during cancer treatment can become serious very quickly. Call immediately if you have any signs of infection, which include the following:
- Fever (oral temperature over 100.4 °F, or as advised by your health care provider), 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 an open cut or sore
- Diarrhea (loose or liquid stools)
- Pain or burning with urination.
- Vaginal drainage or itching.
