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There are three basic types of blood cells. Red blood cells (RBCs), also called erythrocytes, carry oxygen from the lungs to cells throughout the body. Platelets, also called thrombocytes, are involved in blood clotting. White blood cells (WBCs), also called leukocytes, fight infections in the body. WBCs are produced in the bone marrow (the soft, spongy part inside bones).
There are several types of WBCs. One type, neutrophils, make up the majority of WBCs and are the body’s main defense against infections. Neutrophils are measured in terms of an absolute neutrophil count (ANC), or the percentage of WBCs that are neutrophils in the blood. A normal neutrophil count is typically between 2500 and 6000. A low neutrophil count is generally below 1500 or 1000, and is known as neutropenia.
Neutropenia is an abnormally low level of neutrophils in the blood. Because there are not enough neutrophils to destroy harmful bacteria, viruses, and other foreign invaders in the body, a person who is neutropenic has an increased risk of developing an infection. Neutropenia can develop suddenly (over a few hours or days), or gradually (lasting for months or years). The longer neutropenia lasts and the lower the neutrophil count, the greater the risk of developing an infection.
Cancer treatments, particularly chemotherapy medications, are a common cause of neutropenia. Although chemotherapy is given to destroy cancer cells, it can also damage normal cells in the process, including neutrophils. When these infection-fighting white blood cells are used up or destroyed faster than the bone marrow can make new ones, neutropenia may result.
The following are some other possible causes of neutropenia:
When your neutrophil count is low, you become vulnerable to infections. Therefore, during cancer treatment, your doctor will do routine blood tests, such as a complete blood count (CBC), to check the levels of WBCs, RBCs, and platelets in your blood. Sometimes, a sample of bone marrow may be taken as well.
Nadir is a term used to describe the point after cancer treatment when blood counts are at their lowest. The nadir for each blood cell type will occur at different times. Usually, WBCs will reach their nadir within seven to 14 days after chemotherapy treatment. A person is most vulnerable to infection at this point. Within three or four weeks, the blood counts will slowly rise again to a normal level. The decrease in blood cell counts does not occur at the start of chemotherapy because the drugs affect new blood cells being made in the bone marrow, not the cells already in the bloodstream.
Neutropenia itself does not cause specific symptoms. Therefore, the condition is often discovered by a blood test or if an infection develops. When neutrophil counts are too low to cause signs of the body fighting back, it can be difficult to know if you have an infection. Fever (febrile neutropenia) of 100.5°F or higher is often the first sign of an infection. Most infections occur in the lungs, mouth, throat, sinuses, and skin.
Beyond a fever, other symptoms of neutropenia may include the following:
Treatment for neutropenia includes strategies to avoid infections, detect infections early, and help restore immune system function. Treatment depends on the cause and severity of the disorder. People who have mild neutropenia may not need treatment if the bone marrow recovers by itself. When WBC counts are very low, doctors often prescribe antibiotics as a preventive measure. Doctors may also recommend taking a variety of precautions, such as good hygiene.
If chemotherapy causes neutropenia, neutrophil levels often return to normal when treatment ends. If blood counts have not returned to an acceptable level, your doctor may delay further treatment or recommend a lower dose until your WBC count returns to normal. Also, when neutropenia is caused by cancer itself, treatment of the underlying disorder may resolve the neutropenia.
In addition, drugs or other therapies may be used to treat neutropenia. For example, growth factors (also known as granulocyte-colony stimulating factors, or G-CSFs) may be used to help prevent neutropenia or shorten the time you are neutropenic. Growth factors are administered as a subcutaneous injection (just under the skin) to stimulate the bone marrow to produce neutrophils. Some growth factors for treating neutropenia include filgrastim (Neupogen®), pegfilgrastim (Neulasta®), and sargramostim (Leukine®).
A common side effect of cancer treatment, neutropenia can lead to delays in treatment and reductions in treatment dosage. In addition, for a person who is neutropenic, even a minor infection can quickly become serious. While it may be difficult to prevent neutropenia from occurring, particularly if you are undergoing chemotherapy (which can lower WBC counts), it helps to know ways to reduce your risk of getting an infection when your neutrophil count is low.
NOTE: THIS INFORMATION IS NOT INTENDED NOR IMPLIED TO BE A SUBSTITUTE FOR PROFESSIONAL MEDICAL ADVICE. YOU SHOULD ALWAYS REPORT ANY SIGNS OR SYMPTOMS OF NEUTROPENIA TO YOUR PHYSICIAN IMMEDIATELY.
NOTE: THIS INFORMATION IS NOT INTENDED NOR IMPLIED TO BE A SUBSTITUTE FOR PROFESSIONAL MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF YOUR PHYSICIAN OR OTHER QUALIFIED HEALTHCARE PROVIDER REGARDING NEUTROPENIA.
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