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This section has been reviewed and approved by the PLWC Editorial
Board, 02/05
Neutropenia is an abnormally low level of neutrophils, a type of white blood cell. All white
blood cells help the body fight infection. Neutrophils
fight infection by destroying bacteria. Patients who have neutropenia are at increased risk for developing serious
bacterial infections because there are not enough neutrophils
to destroy harmful bacteria. Neutropenia occurs
in about 50% of patients receiving chemotherapy and is common in patients
with leukemia.
Causes
Neutrophils and other types of white blood
cells are made in the bone marrow (a spongy, fatty tissue found inside
larger bones). Cancer and cancer treatment can cause neutropenia
in several ways:
- Some chemotherapy drugs
can cause the bone marrow to malfunction, lowering the production of
neutrophils.
- Cancers that affect the
bone marrow directly (including leukemia or lymphoma) can crowd
normal bone marrow cells.
- Radiation therapy can
also affect the bone marrow, especially if given to extensive areas of
the body or to bones in the pelvis, legs, chest, or abdomen.
Patients with cancer who are 70 or older or who have a
weakened immune system (due to factors such as HIV infection or a kidney transplantation) are at higher risk for neutropenia. In addition, people with severe or
long-lasting neutropenia are more likely to
develop an infection.
Signs and symptoms
Neutropenia itself does not cause any symptoms.
Patients usually find out they have neutropenia
from a blood test or when an infection develops. Because neutropenia is a common side effect of certain types
of chemotherapy, the doctor will do regular blood tests, usually a
complete blood count (CBC), to look for neutropenia
and other blood-related complications of chemotherapy.
For patients with neutropenia, even a minor
infection can quickly become serious. Talk to your doctor right away if
you experience any of the following signs of infection:
- A fever (temperature of
100.5°F or higher)
- Chills or sweating
- A sore throat or sores
in the mouth
- Abdominal pain
- Diarrhea or sores around
the anus
- Pain or burning when
urinating or frequent urination
- A cough or
breathlessness
- Any redness, swelling,
or pain, particularly around a cut or wound
- Unusual vaginal
discharge or itching
Management and treatment
Depending on the type or dose of chemotherapy, neutrophil
counts generally start to drop about a week after each round of
chemotherapy and usually reach a low point (called the nadir) about seven
to 14 days after treatment. Patients are most vulnerable to infection at
this point. The number of neutrophils then
starts to rise again and may take three to four weeks to reach a normal
level. When the neutrophil level returns to
normal, another round of chemotherapy can begin. If the patient develops neutropenia or the neutrophil
level does not return to normal quickly enough, the doctor may delay the
next round of chemotherapy or recommend a lower dose.
If the chemotherapy commonly causes neutropenia
or if neutropenia is interfering with the
patient's ability to tolerate chemotherapy, the doctor may decide to use
medications called blood growth factors. These include filgrastim (Neupogen), pegfilgrastim (Neulasta),
or sargramostim (Leukine
or Prokine) and they encourage the body to make
more neutrophils or other types of WBCs.
More Information
Managing Side Effects: Infection
PLWC: Managing Side Effects
Cancersymptoms.org: Neutropenia
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