Neutropenia: A Vulnerable Time for Infections

What is neutropenia?

There are many types of white blood cells. Each type has a certain role. But their main job is to fight infection. Neutropenia is a condition in which a person has very low amounts of a type of white blood cell called a neutrophil. White blood cells attack harmful bacteria, viruses, and fungi. So having neutropenia increases the risk of infections.

Who is at risk?

Neutropenia is often seen in people getting chemotherapy or radiation. These treatments can sometimes weaken the immune system by causing myelosuppression, the slowing down of normal production of blood cells.

The degree of neutropenia depends on the cancer treatment used. It also depends on the disease, the stage of the cancer, and where it is located. Also at high risk are those stem cell transplants who high doses of chemotherapy, sometimes with total body irradiation.

Neutropenic effects can build up over time as treatment goes on. If you have round after round of chemotherapy, you are at risk. If you start treatment with an already weak immune system, you're also at risk. Being older and poor nutritional status are other contributing risk factors.

Preventing infection

If you are at high risk for infection with neutropenia, your healthcare providers may give you medicine to help prevent an infection before it actually develops. Bacterial infections are most common. Antibiotics that cover a broad range of bacteria are often used as a preventive treatment. Healthcare providers may call this type of preventive treatment a prophylactic treatment.

The overuse of antibiotics causing resistant strains of bacteria is concerning. But the consequences of not using them are of greater concern. Infections can cause a delay in chemotherapy or radiation treatment. This may negatively affect the long-term effectiveness of these treatments.

If you're getting a transplant or are going to be neutropenic for a long time, you may also be given prophylactic medicine to help prevent infection with a fungus or virus.

Consequences of infection

People with neutropenia may have many different symptoms. But the first and most common one is fever. A fever needs immediate medical care because septic shock can happen. This is a potentially serious and deadly condition in which bacteria quickly spread in the blood.

You may be told to check your temperature twice daily and report any temperature of 100.5°F (38.1°C) or higher to your healthcare provider right away.

Some other things that may be signs of infection are:

• Sore mouth or throat

• White patches on your tongue or in your mouth

• Blisters on the lips or skin

• Sinus pain or pressure or nasal congestion

• Belly pain

• Diarrhea or constipation

• Unusual vaginal discharge or itching

Talk with your healthcare providers about how likely it is that you will be neutropenic and what problems you should watch for.

How to protect yourself if you are neutropenic

To help lower your risk of infection, use good personal hygiene and stay away from things that promote the growth of bacteria. These tips are for people with neutropenia who are outside the hospital:

• Stay away from people with signs of infection

• Stay away from large crowds. Wear a face mask if you can’t avoid crowds.

• Stay away from people who are sick with contagious diseases, including a cold, the flu, measles, or chicken pox.

• Stay away from children who have recently been given live virus vaccines, such as chicken pox and oral polio. They may be contagious to people with very low blood cell counts.

• Bathe daily and wash your hands often, especially after using the bathroom, after touching animals, and before eating.

• Use lotion or oil if your skin becomes dry.

• Clean your rectal area gently but thoroughly after each bowel movement. Let your healthcare provider know if the area becomes irritated or if you develop hemorrhoids.

• Brush your teeth after meals with a soft toothbrush. Talk with your healthcare provider about flossing. Flossing can open new wounds and create an entry for bacteria.

• Avoid accidents and injuries. Be careful not to cut yourself in any way, including the cuticles of your nails. Use an electric shaver instead of a razor to prevent cutting yourself while shaving.

• Don’t squeeze or scratch pimples.

• Clean any cuts and scrapes with soapy warm water right away and apply an antiseptic.

• Don’t garden, clean bird cages, clean fish or turtle tanks, or change cat litter. These can expose you to bacteria.

If you are at very high risk for neutropenia and are admitted to the hospital for more than one week, such as with bone marrow transplants, there may be more. You will often stay in an isolated room. Visitors must wash their hands and wear face masks. You may be advised to eat a low-bacteria diet that leaves out all fresh fruits, vegetables, and undercooked meats and eggs. You may also be advised to stay away from fresh cut flowers or plants that can harbor bacteria.

Warning signs to get medical attention

It is critical to check closely for signs of infection and call your healthcare provider right away if you have any of the following:

• A fever of 100.5°F (38.1°C) 

• Persistent cough

• Shortness of breath

• Burning or pain with urination, or a desire to urinate often

• Shaking chills

• Sweating

• Earaches, headaches, or stiff neck

• Any area of skin with unusual redness or swelling (especially where an IV or shot was)

• A change in mental status

Talk with your healthcare provider about what problems to look for and when to call them. Know what number to call with questions or problems, including after office hours, on weekends, and on holidays.