Neutropenia: A Vulnerable Time for Infections

What is neutropenia?

There are many types of white blood cells. While each type has a specific role, 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 in his or her body. Since white blood cells attack harmful bacteria, viruses, and fungi, neutropenia increases the risk of infections.

Who is at risk?

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

The specific type of treatment influences neutropenia. It also depends on the disease, the stage of the cancer, and where it is located. Also at high risk are those undergoing bone marrow transplants that need myelosuppressive chemotherapy treatments, sometimes with total body irradiation.

Neutropenic effects can build up over the years. If you have round after round of chemotherapy, you are at risk. If you start the current treatment with an already weak immune system, you're also at risk. Advanced age and poor nutritional status are other contributing risk factors.

Preventing infection

If you are at high risk for neutropenia, healthcare providers may give you medicine for an infection before it actually develops. Antibiotics that cover a broad range of bacteria are often used as a preventive treatment for neutropenia. Healthcare providers may refer to this type of preventive treatment as 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.

Consequences of infection

People with neutropenia may have diarrhea, mucositis (irritation of the lining of the mouth), problems with body organs, and fever. A fever needs immediate medical attention 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.

How to protect yourself if you are neutropenic

To lower your risk of infection, use good personal hygiene and avoid things that promote the growth of bacteria. The following suggestions are for people with neutropenia who are outside the hospital:

• Avoid people with signs of infection and avoid large crowds. Wear a face mask if you cannot avoid crowds.

• Avoid 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. Rinse your mouth twice daily with a solution made of water and either salt or baking soda. Temporarily avoid 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 avoid cutting yourself while shaving.

• Do not squeeze or scratch pimples.

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

• Avoid gardening, cleaning bird cages, cleaning fish tanks, or changing cat litter, all of which 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, the restrictions are often more stringent. You will usually stay in an isolated room. Visitors must wash their hands and wear face masks. You will eat a low-bacteria diet that leaves out all fresh fruits, vegetables, and undercooked meats and eggs. You must also avoid 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 report to their healthcare provider or emergency room immediately with the following symptoms:

• 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

• Sore mouth or throat

• Blisters on the lips or skin

• Sinus pain or pressure

• Shaking or chills

• Sweating

• Earaches, headaches, or stiff neck

• Diarrhea or constipation

• Unusual vaginal discharge or itching

• Any area with unusual redness or swelling

• A change in mental status