Neutropenia

Neutrophils are a type of white blood cell that helps your body fight infection. Neutropenia occurs when the number of neutrophils in your bloodstream falls below normal. This puts you at a high risk for infection.

If you have neutropenia, it’s important to take extra precautions to avoid germs that may make you sick. Not having enough neutrophils makes it harder for your body to fight and prevent infections. In severe cases, even bacteria that a healthy body typically tolerates (like the bacteria in your mouth and intestines) can make you sick.

What are some causes of neutropenia?

Chemotherapy and radiation therapy are often the cause of neutropenia because those treatments prevent the production of neutrophils. Patients who have cancers that affect their bone marrow, such as leukemia, lymphoma and myeloma, are also at risk for neutropenia.

Why does cancer treatment cause neutropenia?

Cancer treatments, like chemotherapy, destroy cancer cells. They may also destroy healthy neutrophils and the bone marrow that makes them. Neutropenia is a common side effect of chemotherapy. Neutrophil levels dip to their lowest numbers within the first two weeks following treatment before rising again.

It is crucial to take extra precautions to avoid infections during this vulnerable time.

How is neutropenia diagnosed?

Neutropenia is most often diagnosed by a blood test. The most common test is a simple blood test called a complete blood count (CBC) with differential. Your doctor will likely perform this test regularly to monitor your neutrophil levels if you receive chemotherapy.

If you are diagnosed with neutropenia, your doctor may delay your cancer treatment to give your body time to increase your neutrophil level. Your doctor may also prescribe medicine to boost your number of white blood cells.

Your doctor may order additional tests if they’re unsure what is causing your neutropenia. For instance, they may take a sample of your bone marrow and examine the cells under a microscope. This test can help your doctor tell if neutrophils are developing abnormally in your bone marrow or are being destroyed after they are produced. This information can help your doctor establish a diagnosis.

When should I see my doctor?

Neutropenia can be serious. If your neutrophil count is low, you may be asked to take your temperature several times a day, since a sign of infection is a temperature of 100.4 degrees or greater for more than an hour. If your temperature falls below 98.6 degrees, it could also indicate infection. If either occurs, see your doctor or go to an emergency center immediately.

Sometimes your temperature can be below normal with additional symptoms, which puts you at risk for other serious problems. Call your doctor if you are experiencing symptoms such as:

• Chills, with or without a fever
• Body aches
• Extreme fatigue
• Sore throat
• Mouth sores
• Runny nose
• New or worsening cough
• Redness, swelling or tenderness in any area, including around a catheter site
• Diarrhea
• Vomiting
• Burning or pain with urination (bladder infections that are painful or make you urinate frequently)
• Unusual vaginal discharge or irritation
• Pain in the abdomen or rectum
• Changes in mental status, including confusion or sudden forgetfulness
• Pale skin
• Chest pain, fast heartbeat or shortness of breath
• Cold hands or feet
• Loss of appetite
• Rectal pain or pressure with diarrhea or constipation
• Rashes on your skin
• Dark or red urine

What are the treatments for neutropenia?

Some types of neutropenia might not require treatment. Other treatment options depend on what’s causing your low neutrophil levels.

Treatments may include:

• Antibiotics: Antibiotic treatment can save your life if you have neutropenia with a fever (febrile neutropenia). Your doctor will likely admit you to the hospital, where you’ll get antibiotics intravenously (through a vein) to fight your infection and undergo tests to identify a possible infection.
• Corticosteroids: Your doctor might prescribe corticosteroids if you have an autoimmune condition. These drugs can suppress (lessen) your body’s immune response that is causing the destruction of your neutrophils.
• Granulocyte colony-stimulating factor (G-CSF): Your doctor may also prescribe drugs that promote the production of white blood cells in your bone marrow. You’ll likely receive G-CSF if you’re also receiving chemotherapy.

If your medicine is causing neutropenia, your doctor might adjust your dose or tell you to temporarily stop the treatment.

How can I prevent an infection?

There are many things you can do to prevent infection. Here are some tips:

• Wash your hands with soap and water frequently, especially before eating, after using the restroom and after touching doorknobs.
• Shower daily in lukewarm water.
• Don’t share utensils, cups, food or drinks with others.
• Don’t share towels, razors or toothbrushes with others.
• Never walk barefoot.
• Moisturize dry skin.
• Wear gloves if you’re gardening or working in the yard.
• Prevent the spread of germs by washing fruits and vegetables, keeping meats away from other foods, preparing meals in a clean kitchen and cooking foods to the proper temperature.
• Limit sun exposure.
• Avoid large crowds, gardening and pet waste.
• Wear a hospital mask to prevent exposure to airborne germs.
• Stay up to date on all vaccines, including shots for the flu and COVID-19.
• Avoid picking up pet waste or changing a newborn’s diaper (use gloves and wash your hands afterward if you can’t avoid it).
• Take the medications prescribed by your health care provider to help prevent infections.

Your experience with neutropenia will depend on what is causing your low neutrophil count. If your levels are low because of a recent infection, they’ll likely return to normal once your body has had time to recover. If your neutropenia results from a chronic condition or chemotherapy treatment, your doctor may monitor your levels regularly to prevent complications from infections.

Ask your doctor if medications are necessary to treat your neutropenia and if more frequent check-ups are needed to ensure you remain infection-free.