Fever and neutropenia
White blood cells (WBC’s or leukocytes) are part of the immune system that protects the body against infection. If illness, chemotherapy, or radiation reduces the number of white blood cells available to fight germs, infections may result.
One type of white blood cell, the neutrophil is particularly affected by cancer and cancer treatment. Neutropenia is lowered numbers of neutrophils in the blood. Febrile neutropenia is a more serious condition when neutropenia has allowed an infection, with fever, to develop in the body. It is a serious complication of cancer treatment, sometimes requiring hospitalization.
Your doctor will test your blood for lowered white cells, particularly neutrophils before chemotherapy and, sometimes, between chemotherapy treatments. If your counts are low, you’ll want to take extra precautions to prevent infection.
Avoiding infection during cancer treatment
- Wash your hands thoroughly with soap and water after using the bathroom, coughing, or sneezing. Wash hands before eating. Sing Happy Birthday all the way through as you wash.
- Keep your skin clean with a daily bath or shower.
- Clean cuts or scrapes with soap and warm water and cover them with a bandage.
- Clean your teeth or dentures each day with a soft brush and gentle flossing. Don’t use an alcohol-based mouthwash.
- Avoid crowds and places with lots of people when your counts are low or likely to be low.
- Avoid people and children who are ill, even mildly sick. Ask that people with colds or illness not visit you.
- If you need to change baby diapers, wash thoroughly afterwards.
- Don’t clean up after pets. Have someone else change the cat box.
- Don’t strain having a bowel movement. Use stool softeners or extra fiber and drink lots of liquids to avoid constipation.
- Take care with what you eat and where you eat it. Avoid raw milk, meat, or eggs. Cook fruits, vegetables, and grains. Be sure the people who fix your meals are washing their hands and that food is kept hot or cold during serving times and handled safely.
Knowing when you have an infection
Call your doctor right away if you have a fever (temperature 100.5 degrees Fahrenheit or 38 degrees Celsius or higher.
Other signs of infection include:
- Redness or swelling anywhere on the body. Watch for redness around any injury, surgical wound, or IV site.
- Hot skin. Feeling unusually warm or cold.
- Shaking chills, especially if they are followed by sweating.
- Headache or general body achiness.
- Sore throat or cough.
- Burning when you urinate.
- Feeling confused, dizzy, or weak.
- Unusual vaginal discharge or itching.
- Abdominal pain.
If in doubt, take you temperature and call the doctor or nurse. Be prepared with symptoms and temperature readings.
Medical management of neutropenia
If you have neutropenia, your doctor may reduce your dose of chemotherapy or postpone a treatment or you may be treated with a white cell growth factor drug.
White blood cell growth factors are proteins that help the body produce new white blood cells. They are called hematopoietic (blood-forming) colony-stimulating factors (CSFs). They include Neupogen® (filgrastim),® Leukine (sargramostim), and Neulasta® (pegfilgrastim).
If you have signs of neutropenia and are at high risk for febrile neutropenia, a CSF may be given after chemotherapy to stimulate the body to produce more white blood cells to fight infection.
CSF’s have side effects including aching bones, low-grade fever, and a general sense of not feeling well. Talk to your doctor about managing these side effects and whether your neutropenia can be better controlled with changes in chemotherapy drugs, doses, or scheduling.
Where Can You Go for More Information
NCCN/ACS Fever and Neutropenia: Treatment Guidelines for Patients is a comprehensive handbook for understanding, avoiding, and managing neutropenia and infection during cancer treatment. You can download it as a PDF file or obtain a printed copy from the National Comprehensive Cancer Network.
ASCO Patient Guide: White Blood Cell Growth Factors
provides more information about growth factors and recommendations about their use.
Last Update: April 22, 2008
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