Neutropenia: A Vulnerable Time for Infections

What is neutropenia?

There are many types of white blood cells in your body. Each type has a certain role. The main function of white blood cells 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. White blood cells attack harmful bacteria, viruses, and fungi. So having neutropenia increases the risk for infections. A minor infection may quickly become serious.

Who is at risk?

Neutropenia is often seen in people getting cancer treatments, such as chemotherapy or radiation. These treatments often weaken the immune system by causing myelosuppression, which is the slowing down of the normal production of blood cells.

The degree of neutropenia depends on the cancer treatment used. It also depends on the specific disease, the stage of the cancer, and where it is located. Also at high risk are people who had stem cell transplants and get high doses of chemotherapy, sometimes with total body radiation.

Neutropenic effects can build up over time as treatment goes on. If you have round after round of chemotherapy, you are at risk. If you start treatment with an already weak immune system, you're also at risk. Being older and having poor nutrition are other risk factors.

Preventing infection

If you are at high risk for infection with neutropenia, your healthcare providers may give you medicine to help prevent an infection before it actually develops. Bacterial infections are most common. Antibiotics that cover a broad range of bacteria are often used as a preventive treatment. Healthcare providers may call this type of preventive treatment a prophylactic treatment.

The overuse of antibiotics causing resistant strains of bacteria is concerning. But the consequences of not using them may be of greater concern. Infections can cause a delay in chemotherapy or radiation treatment. This may impair the long-term effectiveness of these treatments.

If you're getting a transplant or are going to be neutropenic for a long time, you may also be given prophylactic medicine to help prevent infection from a fungus or virus. Your healthcare provider may also give you medicines called white blood cell growth factors. These help the body make more white blood cells.

Signs of infection

People with neutropenia may have many different symptoms. But the first and most common 1 is fever. A fever needs immediate care because a serious condition called septic shock can occur. Septic shock 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.

Some other things that may be signs of infection are:

• Sore mouth or throat

• White patches on your tongue or in your mouth

• Blisters on the lips or skin

• Sinus pain or pressure or nasal congestion

• Belly pain

• Diarrhea or constipation

• Unusual vaginal discharge or itching

Talk with your healthcare providers about how likely it is that you will be neutropenic and what problems you should watch for.

How to protect yourself if you are neutropenic

To help lower your risk of infection, use good personal hygiene and stay away from things that promote the growth of bacteria. These tips are for people with neutropenia who are outside the hospital:

• Stay away from people with signs of infection.

• Stay away from large crowds. Wear a face mask if you can’t avoid crowds.

• Stay away from people who are sick with contagious diseases, including a cold, the flu, measles, or chicken pox.

• Ask your healthcare provider if they advise any specific vaccines for you.

• 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. Be sure to wash your feet, groin, armpits, and other moist, sweaty areas.

• Wash your hands often with soap and clean, running water for at least 20 seconds. Do so after using the bathroom, after touching animals, and before eating. If soap and water aren't available, use a hand sanitizer that contains at least 60% alcohol.

• 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. Talk with your healthcare provider about whether you can floss. Flossing can open new wounds and create an entry for bacteria.

• Prevent 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 prevent cutting yourself while shaving.

• Don’t squeeze or scratch pimples.

• Clean any cuts and scrapes with soapy warm water right away and apply an antiseptic. Cover the area with a clean bandage.

• Don’t garden, clean bird cages, clean fish or turtle tanks, or change cat litter. These can expose you to bacteria.

• Don't get manicures or pedicures at a salon.

• Don't use tampons or vaginal suppositories.

• Don't share towels, utensils, or cups with anyone.

If you are at very high risk for neutropenia and are admitted to the hospital for more than 1 week, such as for a bone marrow transplant, you may have an even greater risk. You will stay in an isolated hospital room. Visitors must wash their hands and wear face masks and gowns over their clothing. You may be advised to eat a low-bacteria diet that leaves out all fresh fruits, vegetables, and undercooked meats and eggs. You may also be advised to stay away from 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 call your healthcare provider right away or get immediate medical care if you have any of the following:

• A fever of 100.5°F (38.1°C) 

• Persistent or new cough

• Shortness of breath

• Burning or pain with urination, or a desire to urinate often

• Urine that is bloody or cloudy

• Shaking chills

• Sweating

• Earaches, headaches, or stiff neck

• Any area of skin with unusual redness, drainage, or swelling (especially around an IV, injection site, cut, wound, or catheter)

• A change in mental status

• Unusual vaginal discharge or itching

Talk with your healthcare provider about what problems to look for and when to call. Be sure you know when it would be appropriate to go directly to the hospital. Know what number to call with questions or problems, including after office hours, on weekends, and on holidays.