The Abramson Cancer Center of the University of Pennsylvania
Last Modified: November 1, 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.
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:
Perform excellent daily personal hygiene.
Avoid situations that will increase your chance of getting an infection.
Use extra precautions to decrease the chance of injury and infection.
If you cut or scrape the skin, clean the area immediately with soap and water and bandage as necessary.
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:
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:
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.