What Is Chemotherapy-Induced Neutropenia?

Chemotherapy drugs aim to kill cancer cells in the body. They do this by targeting fast-growing cells and destroying them. Some fast-growing cells being killed are healthy cells that happen to grow fast, not cancer cells. This leads to a wide variety of side effects.

What is neutropenia?

White blood cells (WBCs) are an example of fast-growing cells that can accidentally be killed by chemo drugs. WBCs work together to prevent infection and to keep the human body healthy. Neutropenia happens when chemo reduces the number of a type of WBCs called neutrophils.

Neutropenia can be long-term or short-term in duration.¹ It is often a result of chemo but it can also be caused by:^1,2

• Tumors in your bone marrow (where blood cells are made)
• Radiation of the bone marrow
• Several rare conditions, including autoimmune conditions

Neutropenia can be detected by a blood test called a complete blood count (CBC) test. The condition is classified as mild, moderate, or severe based on the number of neutrophils in your blood. When someone with neutropenia gets a fever, it is called febrile neutropenia. A fever can be a sign of an active infection, so medical attention is needed right away.

What can I do to prevent neutropenia?

Many people on chemo get neutropenia. There is no way to completely prevent it. However, there are several options to help reduce the risk of neutropenia. One of these options is to use a medicine that helps stimulate the growth of WBCs. Drugs containing granulocyte-colony stimulating factor (G-CSF) may help increase the number of neutrophils in your blood. But G-CSF drugs are not the right treatment for everyone. Your doctor will help figure out whether this option is right for you.^1,2

Also, your dosage of chemo drugs can be changed during treatment. Adjusting the amount of chemo drugs may reduce your risk of getting neutropenia or your neutropenia getting more severe. Your dosage schedule and any treatment changes will be based on your personal risk factors. Some of these risk factors for neutropenia include:¹

• Multiple chemo treatments being used at once
• Certain types of chemo treatments
• Other health conditions
• Older age
• Certain types of cancer

Neutropenia can have serious complications. When WBC counts are low, the risk of serious infection is high. Since your body will have a hard time fighting off infection, any infection could be serious. To reduce your risk of infection, you can:^2,3

• Wash your hands regularly and thoroughly
• Avoid sharing food or drinks with others
• Cook meats well and clean produce thoroughly
• Wear gloves when touching live plants, pets, or pet waste
• Regularly clean surfaces such as countertops
• Avoid contact with people who are sick or who have just received a live vaccine (including the chickenpox vaccine)
• Avoid crowds

How is neutropenia treated?

Neutropenia is managed by changing your dose of chemo drugs, delaying chemo, and using G-CSFs when possible. These options may help stimulate WBC growth. However, the body naturally regrows these cells. This means that time and avoiding infections will also eventually lead to more WBCs.^1,2

Neutropenia is very common and may not need aggressive treatment. However, as mentioned, an active infection in the body can get very dangerous with neutropenia. If you have neutropenia and get a fever, seek medical attention now. You may need to be hospitalized for care and monitoring.

If you go to the emergency room with febrile neutropenia, you should not stay in the waiting area for very long. Emergency room waiting areas are full of sick people and germs that can make your infection worse. These germs can also increase your risk of getting another infection. Tell emergency room staff as soon as possible if you or a loved one are there with febrile neutropenia. This way, you can be moved to a different area or seen right away.²

There are signs of active infection besides fever to watch for. If you have neutropenia and notice any of the following, seek medical attention right away:^2,3

• 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