The Family Care Research Program

Information for Patients and Caregivers

Cancer and Treatment-related Low Neutrophil Count (Neutropenia)

How do people describe neutropenia?

The major function of White Blood Cells (WBC’s) is to defend the body against infection. There are many types of WBCs, each playing an important role in your body’s defense system. Neutrophils make up a large percentage of the total WBC, and protect against most types of infections. Neutrophils appear in greatest number in the circulating blood. Neutropenia occurs when there are a decreasing number of circulating neutrophils.

Generally an absolute neutrophil count (ANC) of equal to or less than less 1,499 puts an individual at greater risk for developing an infection (see level of neutropenia below), with the greatest risk for persons with 500 or fewer neutrophils.

Level of Neutropenia

Neutrophil count (cells/µL)	Risk for infection
1,500 or more	No increased risk
1,000-1,499	Slight increased risk
500-999	Moderate increased risk
Fewer than 500	High increased risk

The National Comprehensive Cancer Network: Fever and Neutropenia Guidelines at: http://www.nccn.org

How do people describe neutropenia?

Neutropenia will not necessarily cause you to become sick..You need to be more careful about hand washing, avoiding people who are sick, watching your body for signs of infection, and taking your temperature if you think you have a fever (feel achy, warm or cold with chills).

What happens to people when they have neutropenia?

An infection occurs when germs such as bacteria or viruses grow and make more germs and can cause you to become sick. Your body has a normal defense system that includes your skin, the lining of your gastrointestinal tract (GI tract), your blood cells, and your immune system.

Some people with neutropenia may have a fever, chills or sweating, which can indicate your body is trying to fight off an infection. It becomes much more difficult for the body to help fight infection without as many neutrophils. The longer you are neutropenic, the greater your risk for infection. More than 60% of patients with neutropenia become infected.

What causes neutropenia?

Persons who are undergoing cancer treatments such as chemotherapy or radiation therapy are at greater risk for infection at various times throughout treatment. Chemotherapy is the most common cause of a weakened immune system. Radiation therapy can damage the skin and lining layers, making them less able to keep germs out of your body.

Cancer treatments such as radiation and chemotherapy destroy the most rapidly dividing cells in the body, which includes cancer cells as well as healthy cells, like red blood cells, white blood cells and platelets.

Corticosteroids (decadron, prednisone) used in many treatment protocols further suppress immune function and can mask signs of an infection.

The nadir, or lowest White Blood Cell (WBC) count after treatment, usually occurs 10 to 14 days after treatment.

How do people cope with neutropenia?

While you are having treatment for cancer, you are more likely to have an infection because of fewer neutrophils to fight off germs. Most people are asked to call their doctor or other healthcare provider if they have signs and symptoms of infection.

Signs of infection: What to look for:

Fever of 100.4 of greater
Increased skin temperature
Body aches
Shaking chills
Burning with urination
Headache
Feeling confused, dizzy or weak
Redness, swelling or warmth to an intravenous (IV) site, wound or site of an injury
Diarrhea
Mouth sores or problems swallowing
Sinus tenderness or nasal congestion
Cough or shortness of breath

What to do when you experience neutropenia:

Take your temperature daily, or as recommended by your healthcare team.
Keep a record of your temperature.
Drink plenty of fluids, including water, popsicles and fruit juices.
Get enough rest.
Cover yourself with a blanket if you are chilly or a sheet if you are hot.
Wash your hands with antibacterial soap often and with extra care, but especially after using the bathroom, blowing your nose, or handling raw meat, fruits or vegetables.
Wash the skin of all fresh fruits and vegetables carefully with tap water before preparing or eating them.
Avoid eating raw meat or eggs, and any fish or shellfish during treatment.
Avoid contact with crowds or large groups of people.
Avoid people who you know are sick.
If you have a temperature above 100.7, call your healthcare provider before taking any Tylenol or ibuprofen products.
Wear protective gloves when you are gardening or cleaning up after pets
Clean your rectal area gently but thoroughly after a bowel movement
Avoid salad bars at restaurants. (Many people touching the food, stays at room temperature often for many hours, encouraging bacterial growth).

How can I calculate my Absolute Neutrophil Count (ANC)?

In the complete blood count (CBC), neutrophils are calculated as a percentage. To calculate actual number of neutrophils:

Look at the CBC; add the percentages of neutrophils (sometimes reported as “segs”) and bands (young, immature neutrophils) together.
Multiply the percent by the WBC count

Example: WBC=4.6 (White count is 4,600)

Segs=40 (40% neutrophils)

Bands=5 (5% young neutrophils)

ANC (Absolute Neutrophil Count) = 45% of 4,600 = 45/100 x 4,600 =2,070 neutrophils (no increased risk for infection, see risk for neutropenia, above)

What can family members or friends do to help me with neutropenia?

Ask family members or friends to help you keep track of your temperature when you have a low white blood count.
Ask family members or friends to help you stay free from an infection by washing their hands, and by asking others who visit to wash their hands.
Ask family members or friends to bring you a blanket or warmer clothes if you are chilled.
Ask them to remind you to drink more fluids.

How can I talk with my family members or others about neutropenia?

Tell them how the low white blood count might affect your daily activities.
Explain why you need to stay away from crowds of people and people who are sick.

What should I report to my doctor or nurse?

Fever of greater than 100.7 (at any time)
Pain, burning, redness, swelling or drainage anywhere.
Chills or shaking
Mental confusion

Where can I get more information?

Contact your health care provider
Contact the National Cancer Institute at 1-800-4-CANCER or through the internet at: http://cancer.gov/cancerinformation
Contact the American Cancer Society at 1-800-ACS-2345 or though the internet at: http://www.cancer.org/docroot/MBC/MBC_2x_OtherEffects.asp?sitearea=MBC
Over the internet at http://cancersourcern.com

References:

The National Comprehensive Cancer Network (accessed 2003). Fever and Neutropenia Treatment Guidelines at: http://www.nccn.org
Wilson, BJ (2002). Dietary Recommendations for Neutropenic Patients. Seminars in Oncology Nursing, 18(1): 44-9.
Barber, FD. (2001) Management of Fever in Neutropenic Patients with Cancer. Nursing Clinics of North America, 36(4): 631-644.
CancerSymptoms.org (accessed 1/2003) at: www.cancersymptoms.org/symptoms/neutropenia/