Neutropenia

Neutropenia is a condition that occurs when the level of a certain type of white blood cell (neutrophil) in your body becomes lower than normal. Neutrophils are made in the bone marrow and fight infections. These cells protect against bacteria and viruses. The fewer neutrophils you have, and the longer your body remains without them, the greater your risk of getting a severe infection becomes.

CAUSES

The cause of neutropenia may be hard to determine. However, it is usually due to 3 main problems:

  • Decreased production of neutrophils. This may be due to:

  • Certain medicines such as chemotherapy.

  • Genetic problems.

  • Cancer.

  • Radiation treatments.

  • Vitamin deficiency.

  • Some pesticides.

  • Increased destruction of neutrophils. This may be due to:

  • Overwhelming infections.

  • Hemolytic anemia. This is when the body destroys its own blood cells.

  • Chemotherapy.

  • Neutrophils moving to areas of the body where they cannot fight infections. This may be due to:

  • Dialysis procedures.

  • Conditions where the spleen becomes enlarged. Neutrophils are held in the spleen and are not available to the rest of the body.

  • Overwhelming infections. The neutrophils are held in the area of the infection and are not available to the rest of the body.

SYMPTOMS

There are no specific symptoms of neutropenia. The lack of neutrophils can result in an infection, and an infection can cause various problems.

DIAGNOSIS

Diagnosis is made by a blood test. A complete blood count is performed. The normal level of neutrophils in human blood differs with age and race. Infants have lower counts than older children and adults. African Americans have lower counts than Caucasians or Asians. The average adult level is 1500 cells/mm3 of blood. Neutrophil counts are interpreted as follows:

  • Greater than 1000 cells/mm3 gives normal protection against infection.

  • 500 to 1000 cells/mm3 gives an increased risk for infection.

  • 200 to 500 cells/mm3 is a greater risk for severe infection.

  • Lower than 200 cells/mm3 is a marked risk of infection. This may require hospitalization and treatment with antibiotic medicines.

TREATMENT

Treatment depends on the underlying cause, severity, and presence of infections or symptoms. It also depends on your health. Your caregiver will discuss the treatment plan with you. Mild cases are often easily treated and have a good outcome. Preventative measures may also be started to limit your risk of infections. Treatment can include:

  • Taking antibiotics.

  • Stopping medicines that are known to cause neutropenia.

  • Correcting nutritional deficiencies by eating green vegetables to supply folic acid and taking vitamin B supplements.

  • Stopping exposure to pesticides if your neutropenia is related to pesticide exposure.

  • Taking a blood growth factor called sargramostim, pegfilgrastim, or filgrastim if you are undergoing chemotherapy for cancer. This stimulates white blood cell production.

  • Removal of the spleen if you have Felty's syndrome and have repeated infections.

HOME CARE INSTRUCTIONS

  • Follow your caregiver's instructions about when you need to have blood work done.

  • Wash your hands often. Make sure others who come in contact with you also wash their hands.

  • Wash raw fruits and vegetables before eating them. They can carry bacteria and fungi.

  • Avoid people with colds or spreadable (contagious) diseases (chickenpox, herpes zoster, influenza).

  • Avoid large crowds.

  • Avoid construction areas. The dust can release fungus into the air.

  • Be cautious around children in daycare or school environments.

  • Take care of your respiratory system by coughing and deep breathing.

  • Bathe daily.

  • Protect your skin from cuts and burns.

  • Do not work in the garden or with flowers and plants.

  • Care for the mouth before and after meals by brushing with a soft toothbrush. If you have mucositis, do not use mouthwash. Mouthwash contains alcohol and can dry out the mouth even more.

  • Clean the area between the genitals and the anus (perineal area) after urination and bowel movements. Women need to wipe from front to back.

  • Use a water soluble lubricant during sexual intercourse and practice good hygiene after. Do not have intercourse if you are severely neutropenic. Check with your caregiver for guidelines.

  • Exercise daily as tolerated.

  • Avoid people who were vaccinated with a live vaccine in the past 30 days. You should not receive live vaccines (polio, typhoid).

  • Do not provide direct care for pets. Avoid animal droppings. Do not clean litter boxes and bird cages.

  • Do not share food utensils.

  • Do not use tampons, enemas, or rectal suppositories unless directed by your caregiver.

  • Use an electric razor to remove hair.

  • Wash your hands after handling magazines, letters, and newspapers.

SEEK IMMEDIATE MEDICAL CARE IF:

  • You have a fever.

  • You have chills or start to shake.

  • You feel nauseous or vomit.

  • You develop mouth sores.

  • You develop aches and pains.

  • You have redness and swelling around open wounds.

  • Your skin is warm to the touch.

  • You have pus coming from your wounds.

  • You develop swollen lymph nodes.

  • You feel weak or fatigued.

  • You develop red streaks on the skin.

MAKE SURE YOU:

  • Understand these instructions.

  • Will watch your condition.

  • Will get help right away if you are not doing well or get worse.