Neutropenic precautions: 5 dos and don’ts for this cancer treatment side effect

You may already know that it’s important to wash your hands, wear a face mask and avoid sick people while neutropenic. 

But is there anything else you should — or should not — be doing to avoid infections when you’re immunocompromised by a low white blood cell count during or after cancer treatment? 

We spoke with internal medicine expert Carmen Escalante, M.D., for insight. Here are five precautions she shares with immunocompromised patients and their caregivers. 

1. Watch your diet. 

Raw and undercooked meats, unpasteurized dairy products, and fresh fruits and vegetables may all contain bacteria that could make even otherwise healthy people sick.  

So, if you’re immunocompromised, your care team may recommend that you follow a neutropenic diet until your immune system recovers. This is to help you avoid infections caused by food that wasn’t cleaned properly or cooked long enough to kill pathogens.  

“Neutropenic diets are sometimes suggested for patients with leukemia, lymphoma or multiple myeloma, or those who’ve received a stem cell transplant,” says Escalante. “But check with your doctor to see if a neutropenic diet is right for you.” 

2. Limit your exposure to germs.  

It’s not only important to avoid sick friends and strangers if you have neutropenia. The same goes for close family members. 

“This guideline can be especially hard on grandparents,” notes Escalante. “They really want to see and be around their grandkids. But if the third grader is coughing, the teenager is sneezing and the baby has diarrhea, it’s best to wait until they’re symptom-free.” 

You may also want to avoid public swimming pools and hot tubs. They may not be cleaned or maintained well enough to kill the pathogens that could make you sick. 

3. Pay attention to your skin. 

Even tiny cuts and abrasions need prompt and careful attention when you’re neutropenic. That’s why doctors may tell you to avoid certain activities that could expose you to bacteria or fungi in the environment.  

Don’t garden or do yardwork, for instance, unless you plan to wear thick, protective gloves and a long-sleeve shirt and pants. And, don’t go exploring caves (spelunking) until you’re no longer neutropenic. 

“You really shouldn’t even walk around barefoot in your backyard,” says Escalante. “That might sound a bit extreme, but you don’t want to risk stepping on something sharp that breaks the skin and causes an infection.” 

4. Get enough rest. 

Our bodies do much of their healing while we’re asleep. So, it’s important to address insomnia, whether it’s caused by steroids, pain, anxiety, or hot flashes due to menopause or hormone therapy. 

“Steroids in particular are known for making people feel wired and full of energy,” notes Escalante. “If that’s the case for you, and it’s making it difficult to sleep, talk to your care team. Many times, they can recommend something that might help.” 

5. Seek medical help immediately for a fever. 

One of the most important things to remember about neutropenia is that you should seek help immediately if you develop a fever. That’s because you lack the white blood cells that would normally help you fight off disease, so infections can get worse very quickly. 

Some patients — often those with leukemia or who have recently undergone a stem cell transplant — may already be taking antibiotics to prevent infection.  

“But things can change very rapidly, so don’t wait until your condition is dire to seek help,” Escalante notes. “Call your doctor right away.” 

Request an appointment at MD Anderson online or by calling 1-877-632-6789.