Cancer treatment side effect: Neutropenia

Neutrophils are a type of white blood cell that helps your body fight infection. A condition called neutropenia occurs when the number of the neutrophils in your bloodstream is lower than normal, putting you at risk for illness or infection.

If you receive chemotherapy or radiation therapy, you may develop neutropenia because the cancer treatment prevents the production of neutrophils. Patients who have cancers that affect bone marrow, such as leukemia, lymphoma and myeloma, also may become neutropenic.

To understand more about neutropenia, we spoke with Carmen Escalante, M.D., professor and chair of our General Internal Medicine department.

What are common symptoms of neutropenia?

Neutropenia may not cause symptoms and is most often diagnosed by a blood test. Some patients may be asked to take their temperature regularly throughout the day to monitor for infection. Signs of infection include a temperature of 100.4 or greater for more than one hour.

What does it mean if my doctor says I have febrile neutropenia?

It means that you have both a fever and a low white blood cell count. When this happens, you are often advised to see your doctor right away or go to the emergency center. Your doctor will perform a careful evaluation to look for a source of the fever and prescribe antibiotics. Sometimes, the source of the fever can’t be identified, and this is called a fever of unknown origin (FUO). Antibiotics are still prescribed in this situation, and often the fever resolves as the neutrophils increase.

What are the signs of infection caused by neutropenia?

Typical signs of infection include:

• Fever of 100.4 or higher for more than one hour
• Chills
• Body aches
• Extreme fatigue
• Sore throat or mouth sores
• Runny nose
• New or worsening cough
• Shortness of breath
• Redness, swelling or tenderness in any area, including around a catheter site
• Diarrhea or vomiting
• Burning or pain with urination
• Unusual discharge or irritation
• Pain in the abdomen or rectum
• Stiff neck
• Changes in mental status, including confusion or sudden forgetfulness

What should I do if I think I have an infection?

Contact your doctor or a member of your care team. You may be asked to go to the emergency center for immediate treatment.

What can I do to prevent infection?

I encourage patients to follow these common practices to protect against illness and infection:

• Wash your hands frequently with soap and water;
• Practice good physical and oral hygiene;
• Clean and cook foods completely and avoid raw foods;
• Avoid large crowds and anyone with an infection; and
• Wear a hospital mask in public to prevent exposure to airborne germs.

You can download this educational document for additional prevention measures.

What can happen as a result of neutropenia?

If you are neutropenic, your doctor may temporarily halt your cancer treatment to give your body time to increase its white blood cell levels.

How do doctors manage neutropenia?

Your doctor may prescribe medicine, such as Neupogen, to maintain or boost your white blood cell levels. In addition, you will be closely monitored for signs of infection. If you develop an infection or illness, medications will likely be prescribed to address it.

Be sure to talk with your doctor about any changes you experience as a result of your cancer treatment.

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