Neutropenia (low white blood cell count) and infection

The aim of this information is to help you understand about neutropenia (low white blood cells); preventing infection; and what you should do if you feel unwell or get a temperature at any time throughout the course of your treatment.

What is Neutropenia?

Neutropenia is when your white blood cells, called neutrophils, are low. Neutrophils are a type of white blood cell that helps fight infection. When your neutrophil count becomes low you are less able to fight infections. Neutrophils, along with other types of blood cells, are made in your bone marrow, the spongy part of your bones.

What causes neutropenia?

Many different kinds of chemotherapy, some radiation, and some cancers themselves can cause neutropenia. Other health problems may also contribute to neutropenia. Neutropenia can sometimes occur without causing you any problems. The lower your neutrophil count drops the greater the risk of you developing an infection and the harder it is for your body to deal with the infection on its own.

How will I know if my neutrophils are low?

You will have blood tests at different times throughout your treatment to check your neutrophil count. This is called a white blood cell count. This will indicate the number of neutrophils you have available to fight infection.

How does neutropenia effect my treatment?

If your neutrophil count is low or has not returned to normal, your doctor may delay your next treatment for a few days or the dose of chemotherapy you are given may be reduced. Your doctor will makes these decisions based on your individual circumstances.

What are the signs and symptoms of infection?

The signs and symptoms of an infection may include:

  • a temperature of 38oC or above

  • chills or shakes, unusual sweating

  • cough with yellow or green coloured sputum, shortness of breath

  • sore throat, sores in your mouth

  • redness or swelling on your skin (particularly around a central line)

  • loose or liquid bowel motions

  • passing more urine than normal or a burning feeling when passing urine

  • blood or discharge in your urine

  • discharge from your eyes or ears

  • vaginal discharge and/or itching

  • flu-like symptoms such as body aches and feeling tired

If you develop an infection when your neutrophil count is low, it can be life-threatening and needs to be taken very seriously.

What do you do if you develop a temperature or become unwell?

Even if you feel well and you

  • develop a temperature of 38ºC or higher and/or

  • develop shivers or shakes or begin to feel unwell

Go to your nearest hospital emergency department immediately via an ambulance. It could be life-threatening and has to be taken very seriously. When you arrive at the hospital it is important to tell them the following:

  • that you have cancer

  • the date of your last treatment

  • highest temperature you have had in last 24 hours

  • any chills/shakes

  • any other symptoms

  • any drug allergies (especially to antibiotics)

Are there any drugs that can make more white cells?

Yes, a drug called granulocyte colony stimulating factor (G-CSF). It is only used with certain types of chemotherapy. Your doctor will decide if this drug is suitable for use in your situation.

What can be done to help prevent infections

  • wash your hands on all sides including your finger tips before eating and after using the bathroom, sneezing etc.

    • use a waterless cleaner if you do not have access to soap and water

  • shower every day

    • clean cuts, scrapes, sores and or stings immediately with warm water, soap, and antiseptic

    • do not squeeze or scratch pimples

  • prevent constipation, if you need a laxative, ask your doctor or pharmacist. Avoid rectal suppositories or enemas

  • intercourse should be avoided if severely neutropenic

  • speak to your doctor before you have any dental treatment and let your dentist know that you are receiving treatment

    • brush your teeth with a soft toothbrush after eating and before bedtime.

  • check with your doctor before you receive any immunisations

    • if you are exposed to people who have chickenpox, shingles or measles tell your doctor

  • stay away from large crowds of people until your neutrophil count has improved

  • stay away from construction and building sites where there is a lot of dust

  • wear protective gloves when working outside (do not handle potting mix)

    • avoid handling pet poo or clean fish tanks

While this is a long list of "do's and do nots" it is important to maintain, as much as possible, a normal lifestyle and to enjoy the company of your family and friends.

Dietary considerations

Certain bacteria and viruses carried in food can cause serious infection.

When you are neutropenic it is important to:

  • wash your hands before eating and after handling food

  • clean and cook foods thoroughly

  • thoroughly wash and peel fresh fruit and vegetables

  • wash knives and cutting boards after handling uncooked foods

  • avoid take away meals especially chicken, food kept under hot light and ready made salads

  • avoid shell fish, prawns, oysters, smoked fish, sushi, pate and deli meats

  • avoid soft cheeses such as feta, brie, camembert and blue vein

  • if food needs to be reheated, it should be heated until it is hot throughout and then allowed to cool to the right temperature.

For further information please see the Food Standards Australia - diet information including downloadable brochure 'Listeria and Food: Advice for people at risk' www.foodstandards.gov.au/foodmatters/listeria/