Neutropenia

Neutrophils are a type of white blood cell that helps your body fight infection. A condition called neutropenia occurs when the number of the neutrophils in your bloodstream is lower than normal, putting you at risk for illness or infection.

If you receive chemotherapy or radiation therapy, you may develop neutropenia because the cancer treatment prevents the production of neutrophils. Patients who have cancers that affect bone marrow, such as leukemia, lymphoma and myeloma, also may become neutropenic.

To understand more about neutropenia, we spoke with Carmen Escalante, M.D., professor and chair of our General Internal Medicine department.

What are common symptoms of neutropenia?

Neutropenia may not cause symptoms and is most often diagnosed by a blood test. Some patients may be asked to take their temperature regularly throughout the day to monitor for infection. Signs of infection include a temperature of 100.4 or greater for more than one hour.

What does it mean if my doctor says I have febrile neutropenia?

It means that you have both a fever and a low white blood cell count. When this happens, you are often advised to see your doctor right away or go to the emergency center. Your doctor will perform a careful evaluation to look for a source of the fever and prescribe antibiotics. Sometimes, the source of the fever can’t be identified, and this is called a fever of unknown origin (FUO). Antibiotics are still prescribed in this situation, and often the fever resolves as the neutrophils increase.

What are the signs of infection caused by neutropenia?

Typical signs of infection include:

• Fever of 100.4 or higher for more than one hour
• Chills
• Body aches
• Extreme fatigue
• Sore throat or mouth sores
• Runny nose
• New or worsening cough
• Shortness of breath
• Redness, swelling or tenderness in any area, including around a catheter site
• Diarrhea or vomiting
• Burning or pain with urination
• Unusual discharge or irritation
• Pain in the abdomen or rectum
• Stiff neck
• Changes in mental status, including confusion or sudden forgetfulness

What should I do if I think I have an infection?

Contact your doctor or a member of your care team. You may be asked to go to the emergency center for immediate treatment.

What can I do to prevent infection?

I encourage patients to follow these common practices to protect against illness and infection:

• Wash your hands frequently with soap and water;
• Practice good physical and oral hygiene;
• Clean and cook foods completely and avoid raw foods;
• Avoid large crowds and anyone with an infection; and
• Wear a hospital mask in public to prevent exposure to airborne germs.

You can download this educational document for additional prevention measures.

What can happen as a result of neutropenia?

If you are neutropenic, your doctor may temporarily halt your cancer treatment to give your body time to increase its white blood cell levels.

How do doctors manage neutropenia?

Your doctor may prescribe medicine, such as Neupogen, to maintain or boost your white blood cell levels. In addition, you will be closely monitored for signs of infection. If you develop an infection or illness, medications will likely be prescribed to address it.

Be sure to talk with your doctor about any changes you experience as a result of your cancer treatment.

Request an appointment at MD Anderson online or by calling 1-877-632-6789.

Some cancer treatments can weaken the immune system, making you more susceptible to infections. This means that cancer patients can often be in an immunocompromised, or neutropenic, state.

If you’re undergoing cancer treatment, you may wonder if changing your diet or eating plan to a neutropenic diet would help you avoid ingesting harmful bacteria.

We spoke with Sheila Vo, Room Service Call Manager and a clinical dietitian, to see what else cancer patients should know about neutropenic diets.

What is a neutropenic diet?

Neutropenia is a blood condition where you have fewer white blood cells, or neutrophils, which are an important part of the immune system. They help your body fight infections.

Neutropenic diets involve preparing, cooking and storing all foods in a specific way. These diets eliminate any raw or uncooked vegetables, fruit, meat or unpasteurized dairy products to reduce the risk of getting an infection from foodborne bacteria.

“Neutropenic diets can also be called ‘low-bacterial’ or ‘low-microbial’ diets,” explains Vo.

Why are neutropenic diets sometimes prescribed for people with weakened immune systems?

When raw foods aren’t cleaned or prepared properly, bacteria can move from the gastrointestinal tract to other parts of the body. This can cause infection in patients with weakened immune systems.

“Neutropenic diets used to be commonly prescribed for patients undergoing a stem cell transplant or leukemia treatment,” says Vo.

Which foods are safe to eat on a neutropenic diet? Which aren’t?

If you are following a neutropenic diet, you should avoid meat or eggs that are undercooked, unpasteurized dairy products, and uncooked/unwashed fruits and vegetables. It’s also important to not drink water that has not been distilled, filtered or boiled for at least one minute.

“You want to avoid eating any produce with a skin you can eat, like apples or cucumbers, unless you washed it thoroughly and peeled it,” says Vo. “But some fruits, like bananas or oranges, can be eaten raw after washing because the peel protects it from bacteria.”

Here are some foods that are typically part of a neutropenic diet:

• Commercially packaged cheese and cheese products made from pasteurized milk
• Canned meat or fish or meat spreads
• Well-cooked tofu
• Dried fruits
• Canned or bottled roasted nuts
• Frozen or canned fruits and vegetables
• Cooked pasta, rice and other grains

Should you follow a neutropenic diet?

When it comes to specific diets or food plans for cancer patients, Vo urges caution with a “one-size-fits-all” approach.

“Food safety during cancer treatment depends on the type of cancer and treatment,” says Vo. “Usually, we want our patients to eat as normally as possible. But sometimes, you do have to reduce your risk of infection from food contamination, particularly when your white blood cell counts are lower.”

Vo adds that the neutropenic diet has been studied for many years without a clear consensus from experts on whether it is beneficial for immunocompromised people.

“The most important thing is to discuss any dietary changes with your care provider,” says Vo.

Learn safe food practices

Regardless of the diet or food plan recommended by your care team, cancer patients should follow safe food practices and precautions when preparing and eating meals.

“When in doubt, ask your provider,” says Vo.

These safe food practices include:

• Wash your hands before, during and after food preparation and eating.
• Wash raw foods well before eating them.
• Avoid sharing food with other people.
• Check to make sure food is fresh. Do not cook with foods that look or smell bad.
• Cook meats, fish, poultry and eggs until well done.
• Do not keep refrigerated leftovers for more than three days.
• Keep cold foods at or below 40 degrees Fahrenheit. Keep hot foods above 140 degrees Fahrenheit.
• Clean all cooking and eating utensils, tools and dishware before and after use.

Request an appointment at MD Anderson online or by calling 1-877-632-6789.