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.
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)
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
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