Manage higher risk of infection

A neutrophil is a type of white blood cell that plays an important role in preventing infections throughout your body. Normally, neutrophils make up 50 to 70 percent of your white blood cells. But when the number of neutrophils in your bloodstream drops to an abnormally low level, a condition known as neutropenia occurs. Neutropenia increases your risk for infection and makes it more difficult for infections to resolve if bacteria do enter your body. The lower your neutrophil count, the greater your risk for infection.

What causes neutropenia?

Many types of cancer treatments are designed to attack rapidly dividing cancer cells. Because white blood cells also grow and divide quickly, they may also be damaged by chemotherapy, radiation therapy and biologic therapy (immunotherapy), which can lead to neutropenia. Other factors, including your overall health, also may contribute to neutropenia.

Who is at risk for neutropenia?

Neutropenia is most likely to occur in people receiving a combination of radiation therapy and chemotherapy, but it’s also common in those who receive either treatment alone. Recipients of bone marrow transplants are likely to develop neutropenia as well. Although many people treated for cancer are affected by neutropenia, most never get an infection.

When does neutropenia occur?

When neutropenia is caused by chemotherapy, the neutrophil count usually begins to drop about a week after the start of each treatment cycle and reaches its lowest point (called the nadir) between seven and 14 days after treatment. The number of neutrophils in your bloodstream will then begin to rise, and it may take three to four weeks for your neutrophil count to return to normal. Your count must be normal before you can receive your next chemotherapy treatment.

When neutropenia is caused by biologic therapy or radiation therapy, the dose and the frequency of the treatment determine when the neutrophil count rises and falls.

How is neutropenia managed?

Neutropenia is an expected side effect of several treatments and cannot be prevented. Therefore, it’s important to reduce your risk for infection. The most effective way to prevent infection is frequent handwashing, but you can also take several other preventive measures (Table 1).

Table 1. Ways to prevent infection
Practice excellent personal hygiene
• Wash your hands frequently, especially before eating and after using the bathroom
• Do not cut or pick at your cuticles. Instead, use a cuticle cream
• Brush your teeth after each meal and at bedtime
• Use an 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 might increase your risk for infection
• Avoid people with colds or other infections, as well as 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 it during off-peak times
• Do not handle animal waste, including cat litter and fish tank water
Use extra precaution to reduce your 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
• Ask your oncologist before receiving any vaccines, including the flu vaccine


In addition, your doctor will closely monitor your white blood cell count throughout your cancer treatment. Precautions or treatments will be started as soon as they’re necessary. If your neutrophil count is extremely low, your doctor may delay your next treatment until it has increased. In the meantime, he or she will likely have you follow “neutropenic precautions,” which are extra measures to prevent infection:

  • 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
  • Delaying dental work

Certain growth factors may also help people with an extremely low neutrophil count. These growth factors are special proteins that can stimulate the bone marrow to produce more white blood cells. Types of growth factors include filgrastim (Neupogen), filgrastim-sndz (Zarxio), pegfilgrastim (Neulasta) and tbo-filgrastim (Granix).

In patients who have a high risk for infection, prophylactic (preventive) antibiotics or antifungal medications may be used. If an infection develops, antibiotics are usually administered immediately because cancer-related infections can be emergencies.

When should I talk to my doctor about neutropenia?

Ask your doctor whether your treatment may put you at risk for developing neutropenia.

Call your doctor immediately if you have:

  • Fever (100.5 F or higher), chills and sweating
  • Flu-like symptoms (body aches, general fatigue) with or without fever
  • Cough, shortness of breath and 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 during urination