ONCOLOGY SERVICES - Neutropenia FAQ

What is Neutropenia?
Neutropenia refers to a low level of white blood cells. Because chemotherapy kills both cancerous cells and other normal cells that grow at a fast rate, white blood cells are often destroyed.

Because white blood cells play an important role in preventing infection, any time your white blood cell count drops you are at higher risk of getting infection. What's more, as these cells also help to fight oft infections once they are in the body, it is harder to get over an infection when your white counts are low. Therefore you must do everything that you can to decrease the chance that you will become infected while you are receiving chemotherapy.

Normal white blood cell counts are usually in the range of 4,000-11,000 per mm3 of blood. After receiving chemotherapy, your white count may drop as low as 200 to 500 per mm3.While you are receiving chemotherapy your white blood cell count will be checked frequently. Any time that your white blood cell count drops below 1,000 per mm3 you are considered neutropenic. A nurse will call you at home to review with you special steps that you must take in order to decrease the chance that you will get an infection. These are called Neutropenic Precautions and are discussed in greater detail below.

What can I do to prevent infections ?
It is important to realize that there is nothing that you can do to prevent neutropenia/low white blood cell count that is caused by chemotherapy. However, there are several things that you can do to prevent infections when your white blood cells are low and you are at high risk.

Know what to look for. The signs and symptoms of infection include the following:

• fever, chills, or sweats
• cough, mucous production, shortness of breath, or painful breathing
• soreness or swelling in your mouth, ulcers or white patches in your mouth, or a change in the color of your gums
• pain or burning with urination or an odor to your urine
• redness, pain, or swelling of any area of your skin
• redness, pain, swelling, or drainage from any tube you may have (e.g., Hickman catheter, J-tube, urinary catheter)
• pus or drainage from any open cut or sore

Perform excellent personal hygiene.

• Wash your hands frequently, especially before eating and after using the bathroom.
• Use antiseptic mouthwashes (that contain no alcohol) daily.
• Do not cut or pick at cuticles. Use a cuticle cream instead
• Use a deodorant rather than an antiperspirant. Antiperspirants block sweat glands and therefore may promote infection.
• When menstruating, use sanitary napkins rather than tampons, which may promote infection in neutropenic patients.
• Avoid situations that will increase your chance of getting an infection.
• Stay away from people with colds or other infections.
• Avoid contact with anyone who has recently been vaccinated, including infants and
  children.
• Avoid crowds as much as possible. When going to places where there are often a lot of people (i.e., church.:shopping), try going at off times when it is not as crowded.
• If possible, do not use public transportation. If you must, travel during off-peak times.

Use extra precautions to decrease the chance of injury and infection.

• Always wear shoes to prevent cuts on your feet.
• Protect your hands from cuts and bums. When doing dishes, wear rubber gloves; always use potholders or some other protective covering when cooking or baking; wear gloves when gardening.
• Wear sunscreen with a sun Protection factor (SPF)of at least 15 and avoid getting sunburned.
• When shaving under your arms or your legs, only use an electric razor to avoid breaks in the skin.
• Do not take vaccinations unless they have been approved by your oncologists.
• Avoid activities that may lead to falling and/or injury,including but not necessarily limited to bicycling,rollerblading,skating, and skiing.
• If you cut or scrape your skin, immediately clean the area with soap and water and bandage as necessary.

What are neutropenic precautions?

If your white blood cell count drops to 1,000 per mm3or below, you are neutropenic and a nurse will contact you by phone. Until your count rises, it will be necessary for you to take measures in addition to those discussed above to further decrease your risk for infection. These additional steps are referred to as Neutropenic Precautions.

• Take your temperature by mouth four times each day. Call your doctor immediately if your oral temperature is above 100.5 degrees Fahrenheit.
• Eliminate uncooked foods, which may contain germs, from your diet, including
  -cold soups made from fresh fruits or vegetables
  -salads of raw vegetables or fruits
  -raw meats or fish salads
  -natural cheeses
  -uncooked eggs
  -fresh, frozen, and dried fruits
  -uncooked herbs, spices, and black pepper
  -instant iced tea, coffee, or punch
  -sushi and sashimi
• Avoid fresh flowers and plants that may have germs in the soil.
• Avoid enemas, rectal suppositories, and rectal thermometers.
• Except in an emergency, do not have any dental work performed. If you have an emergency that requires dental work, inform your dentist at the time you schedule your appointment that you are receiving chemotherapy and what your most recent white blood cell count is. You may want to suggest that your dentist contact your oncologist prior to your scheduled-dental work.

When should I call my Doctor?
Even after you have taken special precautions to prevent infection, it is still possible to get one. If any of the following signs or symptoms of infection occur, call your doctor or nurse immediately. Do not take any medications, even aspirin or other products, to lower your temperature, before talking to your doctor.

• oral temperature above 100.5 degrees, which indicates a fever
• cough, mucous production, shortness of breath, or painful breathing . soreness or swelling in your mouth or throat, ulcers or white patches in your mouth, or a
  change in the color of your gums
• pain or burning with urination or an odor to your urine
• change in the odor, character, or frequency of your stool, especially diarrhea
• redness, pain, or swelling in any area of your skin
• redness, pain, swelling in the area surrounding any tube you may have (e.g., Hickman catheter, J-tube, urinary catheter)
• pus or drainage from any open cut or sore or from any tube you may have (e.g., Hickman catheter, J-tube, urinary catheter)
• an overall feeling of being sick, even if you don't have a temperature

Courtesy of Karen T. Bruchak, RN. MSN, MBA, Assistant Administrator, Cancer Clinical Programs, University of Pennsylvania Cancer Center, 6 Penn Tower, 3400 Spruce Street, Philadelphia, PA 19104, OncoLink http://www.oncolink.uperm.edu. Supplement 113. September 1997.

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Last Modified: July 27, 2007 10:09 AM