What Causes Neutropenia?

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:

• Other cancer treatments (e.g., radiation therapy, stem cell/bone marrow transplant)
• Certain cancers (e.g., leukemia, lymphoma)
• Exposure to specific drugs (e.g., antibiotics, diuretics)
• Some diseases or disorders (e.g., congenital disorders, aplastic anemia)
• Viral infections (e.g., influenza)
• Advanced age

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.

A Drop in Blood Cell Counts

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.

Signs and Symptoms of Neutropenia

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:

• Fatigue, body aches
• Chills, sweating
• Sore throat, cough, shortness of breath
• Mouth sores/ulcers
• Nasal congestion
• Abdominal pain
• Diarrhea, sores around the anus
• Redness, swelling, or pain around a wound or sore
• Frequent urination or burning during urination
• Unusual vaginal discharge or itching

Treating Neutropenia

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®).

Reducing the Risk of Infection

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.

Tips for Managing Neutropenia

• Be aware of the signs of infection. During cancer treatment, be alert to early signs of infection, especially fever. A fever can be a sign of a dangerous situation. When your neutrophil count is low, check your temperature twice a day (avoid rectal thermometers). If you develop a fever, let your doctor know right away. Notify your health care team if you notice other signs of infection, such as fatigue, sore throat, shortness of breath, redness, pain, swelling, or a sore/wound that doesn’t heal.
• Keep track of your blood counts. During cancer treatment, your health care team will monitor your blood cell counts. You may want to keep track of this information as well. Record your blood counts in a log so you know when your ANC is low and you need to take extra precautions. If your white blood cell count becomes very low, your doctor may prescribe growth factors to raise your counts before you resume chemotherapy.
• Wash your hands often. Hand washing is an important way to prevent infection. Wash all sides of your hands frequently with warm water and soap. Be sure to wash your hands before eating and touching your face, eyes, nose, and mouth. Also, wash your hands after using the bathroom, shaking hands, coughing, or sneezing. Encourage the other members of your household to do the same.
• Avoid contact with sick people. Until your counts have fully recovered, you can help prevent infection by avoiding large crowds of people, such as shopping malls or other enclosed public areas. Avoid contact with people who are sick with colds, viruses, or other infections, or who have recently received vaccines. Also, do not share food, drinking glasses, utensils, or other personal items (e.g., toothbrushes) with others.
• Keep your skin clean and dry. Practice good hygiene by bathing daily. If needed, apply lotion to prevent dry, cracking skin. If you cut or scrape your skin, clean the area with warm water and soap, apply antiseptic, and cover it with a clean bandage. Also, check your skin daily for any changes and let your health care team know if your skin looks or feels different. If you have a central catheter, check the area for redness or soreness.
• Practice good oral hygiene. Good dental hygiene during and after cancer treatment, including proper cleaning of the mouth and teeth, can help reduce complications, such as mouth sores and infections. Use a soft bristled toothbrush to prevent cuts and rinse your mouth often with sterile water or a bland, non-irritating solution. Your dentist can provide guidance on how to safely keep your mouth clean when your blood counts are low.
• Maintain proper nutrition. A healthy, well-balanced diet can help the body tolerate cancer treatments, fight infection, and rebuild tissue. Food safety is also very important when your neutrophil count is low. To reduce infection risk, avoid raw or undercooked foods, including meats, seafood, eggs, vegetables, or unpeeled fruits. Also, eat or drink only pasteurized juice, milk, yogurt, cheese, or other dairy products. A registered dietitian can help develop a meal plan that works for you.
• Use safety measures. Use caution to avoid any cuts, sores, burns, or other irritations or injuries. Wear protective gloves while doing housework or gardening and avoid sunburn. Avoid places where dust is being blown into the air (e.g., construction sites). Be careful when using sharp objects, such as scissors or knives. Use an electric razor to avoid cuts. Avoid contact with stagnant water (e.g., vases, humidifiers, denture cups). Do not handle animal waste, such as changing the cat litter and cleaning bird cages or fish tanks.
• Maintain a healthy lifestyle. Try to maintain a regular sleep schedule (go to sleep and wake up at the same time each day). Make sure to drink plenty of fluids to prevent dehydration. Also, try to stay as active as possible. A rehabilitation therapist can help determine the type and level of physical activity that is safe and appropriate for you. Depending on your condition, your health care team may want you to limit certain activities, such as intercourse, particularly if you are severely neutropenic.
• Manage stress. Cancer and its treatment can cause a great deal of stress. Ongoing stress can weaken your immune system and make you even more susceptible to infection. It’s important to find ways to reduce stress, such as relaxation techniques, distraction, and meditation. A mind-body therapist, spiritual counselor, and/or support groups can help you manage stress as well.

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.

At Cancer Treatment Centers of America (CTCA), we understand the potential side effects of cancer treatments, like neutropenia, can interfere with your treatment regime and your quality of life.

At CTCA, you'll have your very own team of cancer experts committed to you. Together, you and your care team will develop a comprehensive treatment plan built around your unique needs.

During the course of your conventional treatment, your care team will monitor your blood counts, including your neutrophil count. If your neutrophil count is low, your care team will be as proactive as possible in helping to reduce your risk of infection.

If infection does occur, your care team will provide medications to help you fight it off so you can continue your treatment regime with reduced interruption. Your care team may administer growth factors designed to stimulate the growth of white blood cells, especially if you are receiving chemotherapy and/or radiation therapy.

In addition, throughout your treatment, you will receive various complementary medicine therapies to help reduce side effects and improve your quality of life. This includes nutrition therapy, naturopathic medicine, pain management, oncology rehabilitation, mind-body medicine, and spiritual support.

At CTCA, we understand side effects like neutropenia can interfere with your ability to lead a productive, fulfilling life. We are here to support you so you can move beyond cancer and find healing and hope.

I hope this information has helped you in some way. I will check in with you again next month. In the meantime, stay strong and hopeful.