Table of ContentsView AllTable of ContentsSymptomsCausesDiagnosisTreatmentDecreasing Your Risk of InfectionWhen to Call Your Healthcare Provider
Table of ContentsView All
View All
Table of Contents
Symptoms
Causes
Diagnosis
Treatment
Decreasing Your Risk of Infection
When to Call Your Healthcare Provider
Neutropenia is a concerningside effect of chemotherapyand is defined as a decreased number ofneutrophils(a type of white blood cell) in the blood. Neutrophils are the body’s main defense against bacterial infections, and a reduction in these white blood cells due to chemotherapy can increase the risk of serious and life-threatening infections.
The best treatment is prevention, and there are a number of ways that people can reduce their risk of infections while on chemotherapy.
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There are not any symptoms related to a low neutrophil count per se, but symptoms of an infection often occur due to the lack of neutrophils in the body to fight off bacterial infections. These may include:
Chemotherapy attacks rapidly dividing cells, including cells in the bone marrow that become neutrophils.Some chemotherapy drugs are more likely to cause neutropenia than others.
The dose of chemotherapy is also important, and higher or more frequent doses of chemotherapy drugs (such as dose dense therapy with breast cancer) are more likely to result in neutropenia than lower doses.
Very high dose chemotherapy, such as that used prior to bone marrow transplantation, can cause severe neutropenia, and it is neutropenia that is responsible for the significant mortality related to this procedure.
Timing
Neutrophil counts usually begin dropping three to seven days after treatment and reach their lowest point roughly seven to 12 days following a chemotherapy infusion.This time, referred to as thenadir, is when people have the greatest risk of developing an infection. Depending on the particular chemotherapy regimen, neutrophil counts usually return to normal three weeks to four weeks after an infusion.
Your healthcare provider will order acomplete blood count (CBC)before and after chemotherapy to determine yourwhite blood cell count (WBC). Your total white blood cell count is usually in the range of 4,000 to 11,000 white blood cells per microliter.
Your healthcare provider will be interested in your absolute neutrophil count (ANC) which is somewhat lower than your total white count. A normal ANC is in the range of 2,500 to 6,000 neutrophils per microliter. There are three degrees of neutropenia:
The treatment of neutropenia will depend on many factors, depending on the degree of neutropenia, the medications you are receiving, and symptoms. In some cases, medications to stimulate the production of neutrophils are used preventively following chemotherapy.
Delaying Chemotherapy
If your white count becomes too low, it may be necessary to hold off on your next dose of chemotherapy. In fact, a 2015 study noted that neutropenia is the most common reason why doses of chemotherapy drugs need to be delayed.
That said, delaying chemotherapy might decrease its effectiveness, and your oncologist may recommend treatment to raise your neutrophil count instead. In settings where this is not possible, such as in preparation for a stem cell transplant, hospitalization and isolation are usually needed.
Preventative Antibiotics
Sometimes antibiotics are used preventatively before you have any signs of infection.
Medications
Medications (leukocyte growth factors) may be used to stimulate the production of neutrophils in your bone marrow (preventively or as a treatment for a low neutrophil count). These include:
The most common side effect is bone pain, and there is also some risk of an allergic reaction. There are advantages and advantages to each of these medications, and your oncologist can help determine which is right for you.
Neulasta vs. Neupogen for Neutropenia
Treatment of Infections
Infections can be very serious when you lack the white blood cells to fight off bacteria. If you have an infection in this setting, your oncologist will usually recommend hospitalization with intravenous antibiotics. Antibiotic treatment with broad-spectrum antibiotics is also recommended for those who have “febrile neutropenia,” a fever that suggests an infection even if the source of the infection is not obvious.
In addition to any treatment your oncologist recommends, there are several things you can do tolower your risk of infection during chemotherapy:
You should let your oncologist know if you are experiencing any signs of infection. You will probably be given guidelines on when to call, but certainly let your oncologist know right away if you have a temperature over 100.4 degrees, chills, sweats, or other signs of a serious infection. Keep in mind that your healthcare provider will want to know if you have a fever, even if you don’t have any signs of infection.
A Word From Verywell
Neutropenia due to chemotherapy can be serious, but fortunately there are now treatments that can improve and sometimes prevent neutropenia in the first place. Even if you are receiving these treatments, however, measures to reduce your risk of infection are important. As with other areas of cancer treatment, understanding your blood counts and being your own advocate in your care not only helps you stay in the driver seat of your journey, but may affect outcomes as well.
13 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Witter AR, Okunnu BM, Berg RE.The essential role of neutrophils during infection with the intracellular bacterial pathogenListeria monocytogenes.J Immunol.2016;197(5):1557-65. doi:10.4049/jimmunol.1600599Lustberg MB.Management of neutropenia in cancer patients.Clin Adv Hematol Oncol. 2012;10(12):825-826.Centers for Disease Control and Prevention.What you need to know: neutropenia and risk for infection.Chemocare.Nadir.Ada Health.White blood cell count.MD+Calc.Absolute neutrophil count (ANC).Dinan MA, Hirsch BR, Lyman GH.Management of chemotherapy-induced neutropenia: measuring quality, cost, and value.J Natl Compr Canc Netw.2015;13(1):e1-e7. doi:10.6004/jnccn.2015.0014Gafter-gvili A, Fraser A, Paul M, et al.Antibiotic prophylaxis for bacterial infections in afebrile neutropenic patients following chemotherapy.Cochrane Database Syst Rev.2012;1:CD004386. doi:10.1002/14651858.CD004386.pub3DrugBank.Leukocyte growth factor.Taplitz RA, Kennedy EB, Bow EJ, et al.Outpatient management of fever and neutropenia in adults treated for malignancy: American Society of Clinical Oncology and Infectious Diseases Society of America clinical practice guideline update.J Clin Oncol. 2018;36(14):1443-1453. doi:10.1200/JCO.2017.77.6211American Cancer Society.Infections in people with cancer.UPMC Hillman Cancer Center.Neutropenia (low neutrophil count).American Dental Association.Cancer therapies and dental considerations.
13 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Witter AR, Okunnu BM, Berg RE.The essential role of neutrophils during infection with the intracellular bacterial pathogenListeria monocytogenes.J Immunol.2016;197(5):1557-65. doi:10.4049/jimmunol.1600599Lustberg MB.Management of neutropenia in cancer patients.Clin Adv Hematol Oncol. 2012;10(12):825-826.Centers for Disease Control and Prevention.What you need to know: neutropenia and risk for infection.Chemocare.Nadir.Ada Health.White blood cell count.MD+Calc.Absolute neutrophil count (ANC).Dinan MA, Hirsch BR, Lyman GH.Management of chemotherapy-induced neutropenia: measuring quality, cost, and value.J Natl Compr Canc Netw.2015;13(1):e1-e7. doi:10.6004/jnccn.2015.0014Gafter-gvili A, Fraser A, Paul M, et al.Antibiotic prophylaxis for bacterial infections in afebrile neutropenic patients following chemotherapy.Cochrane Database Syst Rev.2012;1:CD004386. doi:10.1002/14651858.CD004386.pub3DrugBank.Leukocyte growth factor.Taplitz RA, Kennedy EB, Bow EJ, et al.Outpatient management of fever and neutropenia in adults treated for malignancy: American Society of Clinical Oncology and Infectious Diseases Society of America clinical practice guideline update.J Clin Oncol. 2018;36(14):1443-1453. doi:10.1200/JCO.2017.77.6211American Cancer Society.Infections in people with cancer.UPMC Hillman Cancer Center.Neutropenia (low neutrophil count).American Dental Association.Cancer therapies and dental considerations.
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Witter AR, Okunnu BM, Berg RE.The essential role of neutrophils during infection with the intracellular bacterial pathogenListeria monocytogenes.J Immunol.2016;197(5):1557-65. doi:10.4049/jimmunol.1600599Lustberg MB.Management of neutropenia in cancer patients.Clin Adv Hematol Oncol. 2012;10(12):825-826.Centers for Disease Control and Prevention.What you need to know: neutropenia and risk for infection.Chemocare.Nadir.Ada Health.White blood cell count.MD+Calc.Absolute neutrophil count (ANC).Dinan MA, Hirsch BR, Lyman GH.Management of chemotherapy-induced neutropenia: measuring quality, cost, and value.J Natl Compr Canc Netw.2015;13(1):e1-e7. doi:10.6004/jnccn.2015.0014Gafter-gvili A, Fraser A, Paul M, et al.Antibiotic prophylaxis for bacterial infections in afebrile neutropenic patients following chemotherapy.Cochrane Database Syst Rev.2012;1:CD004386. doi:10.1002/14651858.CD004386.pub3DrugBank.Leukocyte growth factor.Taplitz RA, Kennedy EB, Bow EJ, et al.Outpatient management of fever and neutropenia in adults treated for malignancy: American Society of Clinical Oncology and Infectious Diseases Society of America clinical practice guideline update.J Clin Oncol. 2018;36(14):1443-1453. doi:10.1200/JCO.2017.77.6211American Cancer Society.Infections in people with cancer.UPMC Hillman Cancer Center.Neutropenia (low neutrophil count).American Dental Association.Cancer therapies and dental considerations.
Witter AR, Okunnu BM, Berg RE.The essential role of neutrophils during infection with the intracellular bacterial pathogenListeria monocytogenes.J Immunol.2016;197(5):1557-65. doi:10.4049/jimmunol.1600599
Lustberg MB.Management of neutropenia in cancer patients.Clin Adv Hematol Oncol. 2012;10(12):825-826.
Centers for Disease Control and Prevention.What you need to know: neutropenia and risk for infection.
Chemocare.Nadir.
Ada Health.White blood cell count.
MD+Calc.Absolute neutrophil count (ANC).
Dinan MA, Hirsch BR, Lyman GH.Management of chemotherapy-induced neutropenia: measuring quality, cost, and value.J Natl Compr Canc Netw.2015;13(1):e1-e7. doi:10.6004/jnccn.2015.0014
Gafter-gvili A, Fraser A, Paul M, et al.Antibiotic prophylaxis for bacterial infections in afebrile neutropenic patients following chemotherapy.Cochrane Database Syst Rev.2012;1:CD004386. doi:10.1002/14651858.CD004386.pub3
DrugBank.Leukocyte growth factor.
Taplitz RA, Kennedy EB, Bow EJ, et al.Outpatient management of fever and neutropenia in adults treated for malignancy: American Society of Clinical Oncology and Infectious Diseases Society of America clinical practice guideline update.J Clin Oncol. 2018;36(14):1443-1453. doi:10.1200/JCO.2017.77.6211
American Cancer Society.Infections in people with cancer.
UPMC Hillman Cancer Center.Neutropenia (low neutrophil count).
American Dental Association.Cancer therapies and dental considerations.
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