What Is Chemotherapy-Induced Neutropenia?

Chemotherapy treatments aim to kill cancer cells in the body. These medications target fast-growing cells in the body and destroy them. While some of the fast-growing cells being killed by these drugs are cancer cells, there are other healthy cells that grow quickly that can also get killed by chemotherapy, leading to a wide variety of side effects.

What is neutropenia?

White blood cells (WBCs) are an example of a quick-growing cell type that can accidentally be targeted by chemotherapy. All of these WBCs work together to prevent infection and to keep the human body healthy. Chemotherapy can reduce the number of these white blood cells if they are killed during treatment. One common form of this is neutropenia, in which WBCs called neutrophils are significantly reduced in number. Neutropenia is often caused as a result of chemotherapy, but can also be caused by tumors in the bone marrow (where blood cells are made), radiation of the bone marrow, and several autoimmune or rare conditions.^1,2

Neutropenia can be detected by a blood test, called a complete blood count (CBC) test. From there, neutropenia can be classified as mild, moderate, or severe, based on the number of neutrophils in the blood. When an individual with neutropenia develops a fever, it is called febrile neutropenia, and medical attention is often needed immediately since a fever can be a sign of an active infection. Neutropenia can be long-term or short-term in duration.¹

What can I do to prevent neutropenia?

Neutropenia is a side effect for many individuals receiving chemotherapy. Currently, there is no way to prevent this from happening altogether; however, there are several options to help reduce the risk of developing neutropenia. One of these options is to use a medication that helps stimulate the growth WBCs. Medications called granulocyte colony-stimulating factor (G-CSF) may help increase the number of neutrophils in an individual. It’s important to note that G-CSFs are not an appropriate treatment option for everyone. Your doctor or healthcare team will help determine if this option is right for you.^1,2

Additionally, the dosage of chemotherapy given to an individual with cancer can be changed during treatment. By adjusting the amount of chemotherapy a person receives at certain times during treatment, it may be possible to reduce the risk of developing neutropenia or more severe neutropenia. Your dosage schedule and any treatment changes will be based on your personal risk factors. Some of these risk factors for neutropenia include multiple chemotherapy treatments being used at once, the type of chemotherapy treatment used, other health conditions, older age, and type of cancer being treated.¹

One of the most important things to consider when thinking about neutropenia is preventing serious complications as a result of the condition. When WBC counts are low, the risk of serious infection is high. Since the body will have a hard time fighting off infection, any infection could be serious. This is why it is important to practice infection risk-reducing behaviors when experiencing neutropenia, such as:

• Regular and thorough hand washing
• Avoiding sharing food or drinks with others
• Cooking meats well and cleaning fruits and vegetables thoroughly
• Wearing gloves when touching live plants, pets, or pet waste
• Regularly cleaning household surfaces, such as countertops
• Avoiding contact with people who are sick or who have just received a live vaccine (including the chicken pox vaccine)
• Avoiding crowds^2,3

How is neutropenia treated?

Neutropenia is managed by changing the dosage of chemotherapy, delaying chemotherapy treatment, and utilizing medications (C-GSFs) when appropriate. These options may help stimulate WBC growth; however, time and avoiding infections will also eventually lead to increased WBC counts as the body naturally re-grows these cells. Neutropenia is very common and may not need aggressive treatment. However, as mentioned earlier, an active infection in the body may lead to devastating effects. An individual with neutropenia who develops a fever should seek medical attention immediately. Some individuals will need to be hospitalized to receive appropriate care and monitoring.^1,2

One major thing to note is that if an individual goes to the hospital with febrile neutropenia, they should not wait in the emergency room waiting area for very long. Emergency room waiting areas are often full of sick people and germs that can make a current infection worse, or increase the risk of developing another infection. For this reason, it is important to alert the emergency room staff immediately if you or a loved one are there for treatment of neutropenia with a fever, so you can be moved to a different location or be seen immediately.²

In addition to a fever, there are other signs of active infection to watch for. If you have neutropenia and notice any of the following signs of infection, seek medical attention immediately:

• Chills and/or sweats
• Shortness of breath
• Stuffy nose, sore throat, or a new or worsening cough
• Changes in urination, including pain, burning, or an increase in the need to urinate
• A change in the color or clarity of urine
• Vomiting
• Changes in mental status
• Redness, pain, swelling, or soreness in any area, including anywhere on the skin or around any open wounds
• Neck stiffness, headache, ear pain, or sinus pain
• Diarrhea or pain in the abdomen or rectum
• Sores in your mouth or on your tongue
• While coating in your mouth or on your tongue^2,3