Updated December 30, 2014.

Neutropenia (a low number of neutrophils in the blood), is a concerning side effect of chemotherapy, since these cells protect us from developing infections.

What is Neutropenia?

Neutropenia is defined as a decreased blood level of a type of white blood cell known as neutrophils.  This form of white blood cells protect us from developing bacterial infections.

 

What Causes Neutropenia During Lung Cancer Treatment?

Chemotherapy attacks rapidly dividing cells, including cells in the bone marrow that become neutrophils.

Diagnosis

Your doctor will order a complete blood count (CBC) before and after chemotherapy to determine your white blood cell count (WBC). Your total white blood cell count is usually in the range of 4,000 to 10,000 white blood cells per cubic millimeter. Your doctor will be interested in your absolute neutrophil count (ANC) which is somewhat lower than your total white count. A normal ANC is in the range of 2,500 to 6,000 neutrophils per cubic millimeter. There are 3 degrees of neutropenia:

• ANC of 1000 to 1500 – mild (meaning a minimal risk of infection)
• ANC of 500 to 1000 – moderate (associated with a moderate risk of infection)
• ANC less than 500 – severe (indicating a high risk of developing an infection)

Symptoms

Symptoms of neutropenia are related to infections that can develop when your body does not have enough neutrophils to fight off bacteria. These may include:

• A fever greater than 100.5 degrees F
• Shaking chills
• Sore throat
• Cough
• Shortness of breath
• Burning with urination or blood in your urine

• Low back pain (sign of a possible kidney infection)
• Diarrhea
• Rashes
• Redness, swelling, or drainage around an injury or other entry to the body such as a Port or IV line

Treatment

If your white count becomes too low, it may be necessary to hold off on your next dose of chemotherapy. That said, delaying chemotherapy might decrease its effectiveness, and your oncologist may recommend treatment. Options for treatment include:

• Preventative Antibiotics – Sometimes antibiotics are used preventatively, before you have any signs of infection.
• Medications – Medications (growth factors) may be used to stimulate production of neutrophils in your bone marrow (preventively or as a treatment for a low neutrophil count). These include:
  • Filgrastim, G-CSF (Neupogen)
  • Pegfilgrastim (Neulasta)
  • Sargramostim, GM-CSF (Leukine)

Treatment of Infections When Neutropenia is Present

Infections can be very serious when you lack the white blood cells to fight off bacteria. If you have an infection in this setting your oncologist will usually recommend hospitalization with intravenous antibiotics.

Coping

In addition to any treatment your oncologist recommends, there are several things you can do to lower your risk of infection at this time:

• Practice careful hand washing (yourself and your loved ones) – This is the most important thing you can do to lower your risk
• Use liquid soap instead of bar soap
• Stay away from people with infections
• Avoid large crowds, for example, shopping malls and movie theaters
• Avoid children (and adults) that have recently received vaccinations with live viruses, such as the chickenpox vaccine
• Skip any immunizations (for example the flu shot or pneumonia shot) until you discuss these with your oncologist
• Avoid any dental work until you discuss it with your oncologist
• Avoid raw eggs and undercooked meat, fish, or seafood. Use Safe Cooking Practices
• Pets can be a source of infection when your white blood cell count is low – Have someone else change the litter box, clean the bird cage, or change the fish tank. Avoid handling reptiles. This is real reason to step back and allow others to help –- take advantage of it.
• Ask your physician before using medications such as acetaminophen (Tylenol). These can mask a fever
• Women should avoid tampons, and use sanitary napkins instead
• Use an electric shaver
• Avoid cutting your cuticles. It is best to avoid manicures and pedicures as well until you complete chemotherapy
• Practice good skin care. Address skin conditions related to chemotherapy with your oncologist

When to Call Your Doctor

You should let your oncologist know if you are experiencing any signs of infection. He will probably give you guidelines on when to call, but certainly let him know right away if you have a temperature over 100.5 degrees F, shaking chills, or other signs of a serious infection.
Further Reading:

• Bone Marrow Suppression During Chemotherapy
• Anemia (Low Red Blood Cell Count) from Chemotherapy
• Thrombocytopenia (Low Platelets) from Chemotherapy

<sub>Sources:

American Cancer Society. Infections in People with Cancer. Accessed 10/21/14. http://www.cancer.org/docroot/ETO/content/ETO_1_2X_Infections_in_People_with_Cancer.asp.

Crea, F. et al. Pharmacologic rationale for early G-GSF prophylaxis in cancer patients and role of pharmacogenetics in treatment optimization. Critical Reviews in Oncology/Hematology. 2008. Dec 24. (Epub ahead of print).

D’Souza, A. et al. Granulocyte colony-stimulating factor administration: adverse events. Transfusion Medicine Reviews. 2008. 22(4):280-90.

Lyman, G. and M. Shayne. Granulocyte colony-stimulating factors: finding the right indication. Current Opinions in Oncology. 2007. 19(4):299-307.

Pascoe, J. and N. Steven. Antibiotics for the prevention of febrile neutropenia. Current Opinions in Hematology. 2009. 16(1):48-52.</sub>