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Neutropenia: A Vulnerable Time for Infections

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What is neutropenia?

There are many types of white blood cells, each with specific roles, but their main job is to fight infection. Neutropenia is a condition in which a person has very low amounts of a type of white blood cell called a neutrophil in their body. Since white blood cells attack harmful bacteria, viruses, and fungi, neutropenia increases the risk of infections.

Who is at risk?

Neutropenia is often seen in people receiving chemotherapy or radiation, which can temporarily weaken the immune system or cause myelosuppression, the slowing down of normal production of blood cells.

The specific type of treatment influences neutropenia. It also depends on the disease, the stage of the cancer, and where it is located. Also at high risk are those undergoing bone marrow transplants that require myelosuppressive chemotherapy treatments, sometimes with total body irradiation.

Neutropenic effects can accumulate over the years. If you've received round after round of chemotherapy, you are at risk. If you start the current treatment with an already weak immune system, you're also at risk. Advanced age and poor nutritional status are other contributing risk factors.

Preventing infections

If patients are at high risk for neutropenia, doctors may give them medication for an infection before it actually develops. Antibiotics that cover a broad range of bacteria are often used as a preventive treatment for neutropenia. Doctors may refer to this type of preventive treatment as prophylactic treatment.

The overuse of antibiotics causing resistant strains of bacteria is concerning, but the consequences of not using them are of greater concern. Infections can cause a delay in chemotherapy or radiation treatment that may negatively affect the long-term effectiveness of these treatments.

Consequences of infection

People with neutropenia may have diarrhea, mucositis (irritation of the lining of the mouth), problems with body organs, and fever. A fever requires immediate medical attention or septic shock, a potentially serious and deadly condition in which bacteria quickly spread in the blood, can occur.

Patients may be told to check their temperature twice daily and report any temperature of 100.5 degrees Fahrenheit or higher to their doctor right away.

How to protect yourself if you are neutropenic

Good personal hygiene and avoiding things that promote the growth of bacteria lower the risk of infection. The following suggestions are for people with neutropenia who are outside the hospital:

  • Avoid people with signs of infection and avoid large crowds. Wear a face mask if you cannot avoid crowds.

  • Avoid people who are sick with communicable (contagious) diseases, including a cold, the flu, measles, or chicken pox.

  • Stay away from children who have recently been given live virus vaccines, such as chicken pox and oral polio, as they may be contagious to people with very low blood cell counts.

  • Bathe daily and wash your hands frequently, especially after using the bathroom, after touching animals, and before eating.

  • Use lotion or oil if your skin becomes dry.

  • Clean your rectal area gently but thoroughly after each bowel movement. Let your doctor know if the area becomes irritated or if you develop hemorrhoids.

  • Brush your teeth after meals with a soft toothbrush. Rinse your mouth twice daily with a solution made of water and either salt or baking soda. Temporarily avoid flossing, which can open new wounds and create an entry for bacteria.

  • Avoid accidents and injuries. Be careful not to cut yourself in any way, including the cuticles of your nails. Use an electric shaver instead of a razor to avoid cutting yourself while shaving.

  • Do not squeeze or scratch pimples.

  • Clean any cuts and scrapes with soapy warm water right away and apply an antiseptic.

  • Avoid gardening, cleaning bird cages, cleaning fish tanks, or changing cat litter, all of which can expose you to bacteria.

For very high-risk neutropenic patients who are admitted to the hospital for more than one week, such as with bone marrow transplants, the restrictions are often more stringent. The patient usually stays in an isolated room, and visitors must wash their hands and wear face masks. Patients will eat a low-bacteria diet that excludes all fresh fruits, vegetables, and undercooked meats and eggs. They must also avoid fresh cut flowers or plants that can harbor bacteria.

Warning signs to get medical attention

It is critical for people with neutropenia to check closely for signs of infection and report to their doctor or emergency room immediately with the following symptoms:

  • A fever of 100.5 degrees Fahrenheit

  • Persistent cough

  • Shortness of breath

  • Burning or pain with urination, or a desire to urinate frequently

  • Sore mouth or throat

  • Blisters on the lips or skin

  • Sinus pain or pressure

  • Shaking or chills

  • Sweating

  • Earaches, headaches, or stiff neck

  • Diarrhea or constipation

  • Unusual vaginal discharge or itching

  • Any area with unusual redness or swelling

  • A change in mental status


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