Neutropenia in cancer patients

This page was reviewed under our medical and editorial policy by

Farah Quyyumi, MD, Medical Oncologist, City of Hope | Glendale

This page was reviewed on June 1, 2023.

With cancer, it’s likely you’ll undergo chemotherapy or radiation treatment at some point. While these treatments are commonly used to fight cancer, they may also result in immunosuppression, or a lowered white blood cell count.

Neutropenia means low levels of neutrophils (a type of white blood cell) in the blood and is typically seen among cancer patients. While all types of white blood cells help the body to fight infection, neutrophils are of key importance. They provide an important defense against infection, specifically bacterial.

During the course treatment, your care team may regularly monitor your neutrophil count. If you have neutropenia, you’re more vulnerable to infections, so it’s important you take precautions to lower the infection risk.

What causes or increases your risk of neutropenia?

Half of cancer patients undergoing chemotherapy experience some degree of neutropenia, putting them at risk of contracting serious infections, according to the American Society of Clinical Oncology. Below are factors that may lower your neutrophil levels:

Certain types of cancer: Cancer itself may cause neutropenia, specifically when the bone marrow is directly affected, as with leukemia, lymphoma and multiple myeloma.

Chemotherapy: During chemotherapy treatment, all fast-growing cells are destroyed, both good and bad. This means that in addition to killing cancer cells, chemotherapy wipes out the white blood cells your body needs to fight off infection. Neutrophil levels are typically at their lowest seven to 14 days after a round of chemotherapy.

Radiation: Similar to chemotherapy, radiation may decrease levels of neutrophils in your blood. Total body irradiation (TBI), in which the entire body is exposed to radiation treatment, is most likely to cause low levels of neutrophils. To prevent immunosuppression caused by radiation, treatment is often broken into several sessions over time, or focused on one area of the body.

Stem cell transplant: This procedure, which includes bone marrow transplants, is done to replace bone marrow cells that have been damaged by cancer or cancer treatments. After this process of taking out healthy cells and using high-dose chemotherapy and radiation, white blood cells are much lower for several weeks. (After some time, the new stem cells take hold, restoring the immune system.)

Immunotherapy: The goal of immunotherapy is to give the body’s immune system a boost, helping it target and attack cancer cells. This type of therapy may alter the way the immune system works overall, and this may increase the risk of infection.

Corticosteroids and antibiotics: Corticosteroids and intravenous (IV) antibiotics may increase the risk of neutropenia, particularly when taken long term and along with chemotherapy. Antibiotics alter bacterial flora (destroying good bacteria along with bad), impairing immune system function. Corticosteroids reduce swelling and inflammation, but also suppress the immune system.

Symptoms of neutropenia

Neutropenia may not cause any symptoms at all. In fact, because your immune system function is reduced, you may not experience the normal warning signs of infection, such as fever, pus, pain, swelling and redness. This is because your body isn’t producing enough of the white blood cells that typically fight off infection and cause these symptoms. In this case, an infection may quickly become serious before any symptoms are apparent, so seek medical attention immediately if you experience the following:

  • Fever over 100.5 degrees Fahrenheit
  • Chills and/or sweats
  • Cough or difficulty breathing
  • Mouth sores, coated tongue or sore throat
  • Abdominal or rectal pain
  • Vomiting or diarrhea
  • Painful urination, bloody/cloudy urine
  • Swelling or redness (especially at catheter site)
  • Skin rash
  • Headache, ear pain, stiff neck or sinus pain

How neutropenia is diagnosed

Because neutropenia often doesn’t cause symptoms until an infection is present, your care team may monitor the levels of neutrophils in your blood regularly via a complete blood count (CBC) test. A CBC blood test provides information on how well your immune system is working by measuring your white blood cell (WBC) count.

Your absolute neutrophil count (ANC) is the level of neutrophils in your blood. By keeping track of this number, your care team may monitor your infection risk. Chemotherapy treatment is scheduled in cycles based on when your ANC is high enough for your body to fight off infection. At times, treatment may need to be postponed until your ANC level is sufficiently robust.

Treatments for neutropenia

If you’re diagnosed with neutropenia, there are several treatment options:

  • Delaying treatment. If your ANC level remains low, chemotherapy and other treatments may be delayed.
  • Prescribing antibiotics during treatment. For extended periods of neutropenia, you may be prescribed antibiotics to lower the infection risk.
  • Prescribing other medications. Sometimes you’ll be prescribed medications called white blood cell growth factors, which help your body make more white blood cells.

To reduce your infection risk, taking the following measures is extremely important:

  • Be diligent about handwashing. Wash your hands regularly with soap and water (particularly before eating), and make sure anyone you come into contact with does the same.
  • Practice good hygiene. Make sure to keep your body clean, as well as any surgical wounds and ports you may have. If you have a catheter, keep the surrounding area clean and dry. Practice good oral hygiene as well.
  • Avoid germs. Stay away from large crowds and don’t come into contact with people who are sick or who have recently had a live vaccine.

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