Neutropenia is a condition where there are low numbers of neutrophils (a kind of white blood cells) in the body, which puts you at risk of illness or infections. Neutrophils are the body’s main defense system that helps the body to fight infections. If neutrophils are lower than normal it is termed neutropenia. It may be due to cancer or as a side effect of chemotherapy or radiotherapy, which increases the risk of infections.

Causes of Neutropenia:

Certain Cancers:

Neutropenia can be caused by cancers that affect bone marrow such as leukemia, lymphoma, and myeloma, and cancers that are spread.

Cancer Treatments:

• Chemotherapy:

  Neutropenia also develops as a side effect of chemotherapy. Neutrophils start dropping within 7 – 14 days after chemotherapy. This period depends on the type and dose of chemotherapy. You are more susceptible to infections during this time. After 3 – 4 weeks neutrophil count starts to rise and become normal because the bone marrow starts producing white blood cells. After getting normal levels of neutrophils you will be ready to receive the next dose of chemotherapy.

• Read about Why Chemotherapy causes Low Blood Count?

• Radiation therapy:

  Neutropenia also develops as a side effect of radiation therapy. If radiation therapy is given to several parts of the body or the bones in the pelvis, legs, chest, or abdomen, it suppresses the activities of bone marrow and prevents the production of neutrophils. 

Anti-cancer drugs:

These drugs work by killing fast-growing cells that include both healthy cells and cancerous cells. During this action, it destroys healthy white blood cells increasing the risk of infections. 

Your health care team will let you know when you are likely to get low white blood cells. It is recommended to follow up with your doctor and go for blood tests to check for neutropenia.

Do You Know How to Deal with the Side Effects of Cancer Medication?

How can I find out if I have neutropenia?

If you are receiving chemotherapy or radiation therapy or affected by blood cancers, you are more likely to get neutropenia. There are no particular signs or symptoms of neutropenia. However, some patients may feel extremely tired or dizzy due to neutropenia. Your health care team will perform blood tests to look for neutropenia.

If you are on chemotherapy, fever may be a sign of infection. Check your body temperature regularly. Inform your health care team if your temperature is 100.4°F or higher. Don’t take any medication to reduce your body temperature without your doctor’s approval. This may hide a worsening infection. If neutropenia is associated with thrombocytopenia, or anemia, patients will face symptoms like weakness or bleeding and bruising.

How can I prevent neutropenia?

There are no possible ways to prevent neutropenia from occurring. But you should prevent the risk of infections while on your cancer treatment.

Here are the best ways to prevent the risk of infections:

• Clean your hands frequently with gentle hand wash
• Avoid contact with sick people and crowded areas
• Practice good physical and oral hygiene
• Don’t share your food, things you use, or other personal items with anyone
• Do regular shower and moisturize your skin with a lotion to prevent dryness and cracking
• Cook the food properly to kill any germs present in them, and avoid raw foods
• Wear a medical mask to prevent exposure to airborne germs
• Drink plenty of fluids every day to avoid constipation
• Never walk barefoot
• Cover scrapes or wounds if any with bandages
• Limit sun exposure
• Wash fruits and vegetables before using
• Protect your skin from bodily wastes and pet wastes. Wash your hands immediately afterward
• Use gloves while gardening, petting, and cleaning household things
• Clean your teeth and gums properly. Use mouthwash if your doctor prescribes it
• Maintain cleanliness in and around your home
• Get the seasonal flu shot if your doctor says to do so
• Stay stress-free, get good sleep and nutrition
• Cancer patients shouldn’t sit in waiting rooms for a longer time. Prefer online consultations if possible or booking an appointment before. This avoids infections that arise from hospitals

Along with your cancer treatments follow these suggestions to prevent infections. Your doctor can also prescribe medications that help increase white blood cells. Infections during cancer treatment can sometimes be life-threatening and require immediate medical attention.

Signs of infection:

• Fever of 100.4°F or higher
• Chills
• Body aches
• Extreme tiredness
• Sore throat or mouth sores
• Runny nose
• Cough 
• Abdominal pain
• Pain and sores near the anus
• Shortness of breath
• Redness, swelling, or tenderness in any area, including the area around a catheter site
• Diarrhea or vomiting
• Burning or pain while urinating
• Unusual vaginal discharge with irritation
• Stiff neck
• Changes in mental status, including confusion or sudden loss of memory

When should I have to go to the emergency room?

If you face symptoms like diarrhea, chills, or a fever of 100.4°F or higher (febrile neutropenia) when you are neutropenic, consult your doctor right away or go to the emergency center. The infections which develop during neutropenia require immediate medical attention. Your doctor will perform some evaluation tests to find out the source of infections and prescribe medications. If you have severe neutropenia, you may need to be hospitalized. Your treating team will take extra care to keep you safe.

Temperature of 100.4°F/38°C or higher is a sign of infection during neutropenia

How is neutropenia treated?

If you are neutropenic, your doctor will;

• Stop your treatment temporarily and give your body sufficient time to increase the levels of white blood cells.
• Postpone the next round or lower the dose of the treatment. 
• Prescribe medication to maintain or boost the production of white blood cells in the blood. During this time, you will be closely monitored for any signs of infection. If any signs are observed medications will be suggested to address them.
• Advise hospitalization when neutropenia is associated with fever which is referred to as febrile neutropenia. Because the body cannot fight active infections during this time. Patients can be safely discharged when the neutrophil count becomes normal and no infections are found.

Risk factors for developing neutropenia in cancer patients:

• Older age
• Comorbidities
• History of multiple chemotherapy regimens
• Radiation therapy
• Chemotherapy for hematologic malignancies
• Bone marrow transplant or stem cell transplant

Questions to ask your health care team about neutropenia:

Prepare a list of questions before you visit with an Oncologist. Add these questions on neutropenia to your list if your treatment plan is suspected to cause neutropenia.

• Does my chemotherapy regimen increase my risk of infections?
• What steps should I have to take to avoid infections?
• When should I seek immediate medical attention or go to the emergency center?
• When should I contact you about any side effects that I face?
• How often should I have to undergo blood tests?
• What important signs of infection should I have to look for?