Lidiando con el Cancer   /   Efectos Secundarios   /   Febrile Neutropenia   /   Recursos

Low White Blood Cell Count/Neutropenia

The Abramson Cancer Center of the University of Pennsylvania
Ultima Vez Modificado: 1 de noviembre del 2001

Neutropenia is a low level of white blood cells. Because radiation therapy and chemotherapy destroy cells that grow at a fast rate, white blood cells are often affected. Patients receiving a combination of radiation therapy and chemotherapy are at greater risk for neutropenia.

Since white blood cells play an important role in preventing infection, any time your white blood cell count drops, you are at higher risk of getting an infection. Since these cells also help to fight off infections once in the body, it may be harder to get over an infection when your white blood cell counts are low. Therefore, you need to take precautions to decrease the chance that you will become infected while receiving treatment.

Normal white blood cells counts are usually in the range of 4,000 - 11,000 per mm3 of blood. While receiving radiation therapy, your white count may drop to lower levels. Your white blood cell count will be checked periodically throughout the course of your treatments to monitor your white count.

Any time that your white blood cell count drops below 1,000 per mm3, you will be considered to be neutropenic. Should this happen, a nurse will review with you special steps that you must take in order to decrease the chance that you will get an infection. These neutropenic precautions are discussed below.

What Can I Do To Prevent Neutropenia?

Since white blood cells are destroyed as a side effect of chemotherapy, there is nothing specifically that you can do to prevent neutropenia from occurring. Nonetheless, there are several things that you can do to reduce your risk of getting an infection when your white blood cells are low:

Taking action at the first signs of infection can help prevent it from spreading and getting worse. There are several signs and symptoms of infection that you should look for, including:

• oral temperature above 100.5o degrees, chills or sweats
• cough, excess mucous, shortness of breath or painful breathing
• soreness or swelling in your mouth, ulcers or white patches in your mouth, or a change in the color of your gums
• pain or burning with urination or an odor to your urine
• change in the odor, character or frequency of your stool, especially diarrhea
• redness, pain or swelling of any area of your skin
• redness, pain, swelling or drainage from any tube you may have (e.g., Hickman catheter, feeding tube, urinary catheter)
• pus or drainage from any open cut or sore
• an overall feeling of being sick, even if you don't have a temperature or any other sign of an infection

Perform excellent daily personal hygiene.

• Wash your hands frequently, especially before eating and after using the bathroom.
• Use alcohol-free, antiseptic mouthwashes daily.
• Do not cut or pick at cuticles. Use a cuticle cream instead. Even if you have a manicure, only cuticle cream should be used.
• Use a deodorant rather than an antiperspirant. Antiperspirants block sweat glands and, therefore, may promote infection.
• When menstruating, use sanitary napkins rather than tampons which may promote infection in a neutropenic patient.

Avoid situations that will increase your chance of getting an infection.

• Stay away from people with colds or other infections.
• Avoid contact with anyone who has recently been vaccinated, including infants and children.
• Avoid crowds as much as possible. When going to places where there are often a lot of people (i.e., church, shopping), try going at off-peak times, when they're not as crowded.
• If possible, don't use public transportation. If you must, travel during off-peak times.

Use extra precautions to decrease the chance of injury and infection.

• Always wear shoes to prevent cuts on your feet.
• Protect your hands from cuts and burns. When doing dishes, wear rubber gloves; always use potholders or some other protective covering when cooking or baking; wear gloves when gardening.
• Wear sunscreen with a sun protection factor (SPF) of at least 15 and avoid getting sunburned.
• When shaving under your arms or your legs, use an electric razor to avoid breaks in the skin.
• Do not receive any vaccination, including the flu vaccine, unless it has been approved by your oncologist.
• Avoid activities that are prone to falling and/or injury, including but not necessarily limited to bicycling, roller-blading, skating, and skiing.

If you cut or scrape the skin, clean the area immediately with soap and water and bandage as necessary.

What Are Neutropenic Precautions?

If your white blood cell count drops to 1,000 per mm3 or below, you are considered to be neutropenic. Until your count rises, it will be necessary for you to take additional measures to further decrease your risk for infection.

These are referred to as "neutropenic precautions" and include:

• Take your temperature by mouth four times each day. Call your oncologist immediately if your oral temperature is above 100.5o Fahrenheit.
• Eliminate uncooked foods, which may contain germs, from your diet, including:
  • cold soups made from fresh fruits or vegetables
  • salads of raw vegetables or fruits
  • raw meats or fish salads
  • natural cheeses
  • uncooked eggs
  • fresh, frozen and dried fruits
  • uncooked herbs, spices and black pepper
  • instant iced tea, coffee or punch
  • sushi and sashimi
• Avoid fresh flowers and plants which may have germs in the soil.
• Avoid enemas, rectal suppositories and rectal temperatures.
• Unless an emergency, do not have any dental work performed. If you have an emergency that requires dental work, inform your dentist when you schedule your appointment that you are receiving chemotherapy and what your most recent white blood cell count is. You may want to suggest that your dentist contact your oncologist prior to your scheduled dental work.

When Should I Call My Doctor?

Even if you have taken great care to prevent an infection, you may still become infected. If any of the following signs or symptoms of infection occur, call your doctor or nurse immediately. Do not take any medications, even aspirin or other products to lower your temperature, before talking to your doctor.

Call your doctor if you have any one or more of the following:

• oral temperature above 100.5o degrees, chills or sweats
• cough, excess mucous, shortness of breath or painful breathing
• soreness or swelling in your mouth or throat, ulcers or white patches in your mouth, or a change in the color of your gums
• pain or burning with urination or an odor to your urine
• change in the odor, character or frequency of your stool, especially diarrhea
• redness, pain or swelling of any area of your skin
• redness, pain, swelling in the area surrounding any tube you may have (e.g., Hickman catheter, feeding tube, urinary catheter)
• pus or drainage from any open cut or sore
• an overall feeling of being sick, even if you don't have a temperature or any other sign of an infection

How is Neutropenia Treated?

One of the most significant advances in the past decades has been the development of "growth factors," which stimulate the body's production of specific substances. One growth factor stimulates the growth of white blood cells and is used frequently with cancer patients, especially those receiving chemotherapy and radiation therapy. By increasing your body's production of white blood cells, this growth factor can decrease your risk of developing an infection.

Growth factors are administered by injection. You may receive the injections from the radiation oncology nurse or you and/or a family member may be taught how to give the injections at home. Once your white blood cell count has returned to a normal level, the injections will be stopped.

If you develop an infection, your doctor will order medications to treat it. Depending on the cause and severity of the infection, the medications may be given either by mouth or through a vein using an intravenous (IV) catheter. If you require IV medications, you may be able to remain at home and have the medications administered by specially trained nurses. Some patients require admission to the hospital in order to effectively treat their infection.

If necessary, your oncologist may decide to delay further treatments until your white blood cell count has returned to normal levels and/or you are free of infection.