Low white blood cells, or neutropenia, can be caused by a couple of factors in patients with blood cancers. First, cancer cells crowding out normal white-blood-cell-producing cells in your bone marrow may cause it. Or it may be a side effect of therapy for your cancer, such as chemotherapy or radiation therapy (radiotherapy). If you have low white blood cell counts, you are at increased risk of developing a serious infection. Therefore, there are a few things you need to know about living with low white cells.
How to Decrease Your Chances of Getting an InfectionThere are a number of things you can do to help prevent an infection:
- Perform good handwashing several times a day, especially before and after eating or food preparation, after using the toilet, or after sneezing or blowing your nose.
- Perform good mouth care.
- Wear gloves when working with soil or out in the garden.
- Use an electric razor instead of a straight blade.
- Avoid large crowds, or people who have recently been sick.
- Take care of your skin, and clean any cuts or scrapes with soap and water immediately.
- Avoid scratching or picking at pimples.
- Do not clean or scoop cat litter boxes or birdcages.
- Cook all meats and fish well, and wash all fruits and vegetables before eating them.
- Avoid taking rectal suppositories or enemas. Keep an eye on your bowel patterns and intervene before you become constipated.
- Ask your healthcare provider about immunizations or flu shots.
- Avoid contact with children who have recently received a live vaccine such as chicken pox, measles, or polio.
- Change towels and handtowels often.
- Do not share drinks or eating utensils with others.
- Do not have plants or fresh flowers in your hospital room.
- For the ladies, use sanitary napkins instead of tampons during your period and avoid vaginal douches or bubble baths.
In some cases, a virus that is lying dormant in your body may cause infection. An example of this may be the herpes virus or chicken pox. These viruses, if not being kept in check by your immune system, may become reactivated and lead to an infection.
Signs of an Infection
In patients with low white blood cells, infections can come on suddenly and progress quickly. Some common signs of an infection are:
- Fever with a temperature greater than 100°F or 38°C
- Sweating, especially at night
- Pain with urination, or frequently voiding small amounts
- Chills or shaking
- Cough that produces green or yellow sputum
- Sore throat
- Redness and swelling at a skin wound
If you are neutropenic, the usual signs that accompany an infection may not be present. Redness, swelling and pus are responses that are created, in part, by white blood cells, and if your counts are low, those signs may not be present. Fever may be the only symptom that you have and should be taken seriously after cancer treatment.
It is important that you have a good working thermometer at home, and know how to use it properly so you can detect a fever early.
Treatment of Neutropenia and Infection
In most cases, your healthcare provider will expect that your treatment will cause a certain amount of neutropenia. However, the longer your immune system is out of order, the more likely you are to get a serious infection. Therefore, your doctor may order a type of drug called a colony stimulating factor.
Colony stimulating factors, such as G-CSF (Filgrastim, Neupogen or Neulasta) or GM-CSF (Sargramostim, Leukine), give your bone marrow a message to start producing white blood cells again. These medications are given as an injection and are often started shortly after treatment, or once your white blood cell count has been low for a couple of days.
Your doctor may also choose to start you on “prophylactic” antibiotics or antivirals; that is, medications to prevent infection from happening. More likely, your healthcare provider will begin antibiotics once they know the cause of your infection.
The Bottom Line
Although neutropenia is a common side effect following treatment for leukemia or lymphoma, it can become very serious, even life-threatening, if an infection develops. It is important to prevent infection and keep on the lookout for signs and symptoms when your counts are low. Treat your fever as an emergency, and contact your healthcare provider right away if you think you have an infection.
Ryan, J. Infection. In Yarbro, C., Frogge, M., Goodman, M., Groenwald, S. eds(2000) Cancer Nursing: Principles and Practice, 5th ed. Jones and Bartlett: Sudbury, MA. (pp.691- 708)