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Neutrophils (new-tro-fils) are a type of white blood cell. White blood cells fight infections or germs. Neutropenia (new-tro-pee-nee-ah) is when the neutrophil count in your blood is too low and your body is less able to fight infections.

Neutropenia - Patient Handout

Neutrophils (new-tro-fils) are a type of white blood cell.

White blood cells are the cells in your body that fight infections or germs. 

Your bone marrow (the spongy part of your bones) produces white blood cells along with other types of blood cells. 

Neutrophils are the first line of defense when your body needs to fight an infection. 

Causes of Neutropenia

Many different kinds of cancer treatments like chemotherapy, radiation therapy, and some cancers themselves can cause neutropenia. 

Your neutrophils can drop low and then return to a normal level without you ever developing an infection.  However, the lower your neutrophils drop, the greater the risk of you developing an infection. 

There are many things that can cause neutropenia:

  • A higher amount or dose of chemotherapy usually causes a lower neutrophil count.

  • Some types of chemotherapy can also cause a greater drop in your neutrophils

  • If you have other health problems besides cancer, such as an HIV infection, then this can also cause neutrophil counts to drop

Neutropenic Fever

If you get a fever when you are neutropenic, it is very important to get immediate medical attention. It could be life-threatening and should be taken very seriously. A variety of tests will need to be done to determine the type of fever. 

They may include the following:

  • urine culture

  • blood cultures from the veins in your arms (and from a central IV if you have one)

  • chest x-ray

  • Physical exam

Broad spectrum antibiotics should be started as soon as possible.

When your neutrophils are low, you have less ability to fight infections. Infections can make you very sick and may cause you to miss your next treatment. Sometimes you might need a lower dose of chemotherapy.

It is important to take steps to prevent infection or to catch an infection early if it is developing. 

It is very important for your doctor and nurses to monitor the number of neutrophils that you have available to fight an infection.  You may hear your nurse or doctor discussing your "counts". They are talking about the number of different cells you have, including:

  • White blood cells (some of these are neutrophils):  cells that fight infection
  • Red blood cells:  cells in your body that carry oxygen to the organs and tissues of your body
  • Platelets (plate-lets):  cells in your body that help your blood to clot. Cancer treatment can make the level of your platelets drop.  This is called thrombocytopenia (throm-bow-sigh-toe-pee-nee-ah)

A blood test will show your cell count. One of these tests  is called a Complete Blood Count (CBC). A CBC is monitored at different times before and during your chemotherapy treatments. 

Cancer treatment can make the levels of all three types of cells drop in your body:

  • When white blood cells (called leukocytes) drop, it is called leukopenia (lu-ko-pe-neeah)
  • When red blood cells are low, it is called anemia (a-nee-mee-ah)

Managing Cancer Related Neutropenia: Hematopoietic Growth Factors (Growth Factors)

"Growth factors" are a medication that is given either as a shot or into a vein through an IV. Growth factors are special proteins that can cause the bone marrow to create more white blood cells, red blood cells or even platelets. They work like your own body does when it is healthy and normal. They are used to prevent neutropenia after certain kinds of chemotherapy. They can also be used to prepare patients for stem cell transplants.

Examples of growth factors for white blood cells are G-CSF (granulocyte colony stimulating factor), GM-CSF (granulocyte-macrophage colony stimulating factor) and IL3 (interleukin 3). They are used only when necessary. They are not used for all patients.  There are different drugs and your doctor or nurses will determine what is best for you.

Side Effects of Growth Factors

Side effects often vary from one person to another. The most common side effect of growth factors, used to increase white blood cells, is bone pain. This may be a dull ache or discomfort in the bones of the back, arms, legs or hips. This can often be relieved with acetaminophen (Tylenol). The pain or discomfort is usually mild and goes away once the injection or injections are completed. Sometimes the skin around the injection site can become red or itchy.  This will disappear when the injections are finished. Fever and chills can happen sometimes with some growth factors.  You will need to tell your doctor or nurse if you experience any side effects.

Signs and Symptoms of Infection

Let your doctor and nurses know right away if you have any of the following symptoms:

  • Fever over 100.5 degrees Fahrenheit or 38 degrees Centigrade. Fever is often the first sign of infection
  • Chills
  • Sweating
  • Cough or shortness of breath
  • Sore throat or sores in your mouth
  • Redness or swelling around sores on your skin or redness and swelling of your skin
  • Loose bowels or liquid stools
  • Trouble urinating and/or increased frequency or burning with urination
  • Vaginal discharge or itching
  • Flu-like symptoms such as body aches and extreme tiredness

Prevention of Infection

  • Wash your hands before eating and after using the bathroom
  • You can use a waterless cleaner if you do not have access to soap and water
  • Be sure to wash all sides of your hands for 10 seconds
  • Good mouth care is important. Brush your teeth with a soft toothbrush after eating and before bedtime
  • Take a warm shower every day.  Hot showers may dry your skin. Pat your skin dry because rubbing it may also cause dryness
  • Try to stay away from people who are sick. Especially stay away from children who have the chicken pox or measles or adults who have shingles
  • Stay away from anyone who has had recent vaccinations and check with your doctor before you have any
  • If you are having problems with your teeth, be sure to check with your doctor first before you see your dentist. Let your dentist know that you are receiving cancer treatment
  • Try to stay away from cleaning up after pets when they go to the bathroom (cats and dogs).  This also includes cleaning fish tanks
  • If your bowel movements ("poop")  are harder than usual, try to be as gentle as possible.  If you become irregular, discuss this with your doctor and nurses
  • Discuss intercourse and lubrication with your doctor and nurses. Practice good cleanliness immediately following intercourse. If you have very low white blood cell counts, avoid intercourse all together

Dietary Considerations

  • Eat a well-balanced diet and drink plenty of liquids
  • Always cook food to the safe internal temperature. You can check this by using a digital food thermometer
  • Wash your hands and surfaces often with warm, soapy water
  • Make sure to always separate your raw foods, such as meat and eggs, from cooked foods and vegetables
  • Always refrigerate food and leftovers promptly at 4°C or below
  • Avoid eating raw or undercooked meat or poultry, such as steak tartar and raw seafood, such as sushi
  • Avoid deli meats and soft cheeses as these may contain a common bacteria call Listeria. With low neutrophils, your body may not be able to fight Listeria like it usually would
  • If you have additional questions about your food choices, please discuss them with your healthcare team

Recommended websites: Neutropenia Websites

Symptom management guidelines: Fever and Neutropenia

Revised Mar 2014

SOURCE: Neutropenia ( )
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