|Low White Blood Cell Count/Neutropenia|
|Carolyn Vachani RN, MSN, AOCN|
|Abramson Cancer Center of the University of Pennsylvania|
| Last Modified: January 27, 2011
White blood cells (WBC) are one part of our body's immune system, working to protect us against infection. A neutrophil is one type of WBC and they make up the majority of WBCs. They are the "first responders" and quickly appear at the site of infection, ingesting and destroying foreign particles. They can be found in the pus of a wound and play a role in acute inflammation (redness, warmth, swelling, and pain). A normal neutrophil count (also called absolute neutrophil count or ANC) is between 2500 and 5000. A low neutrophil count (less than 1000) is known as neutropenia. The lower the neutrophil count, the higher the risk of infection. Neutropenia is most often caused by cancer therapies, including chemotherapy and radiation therapy. Ask your healthcare team when your counts are likely to be at their lowest (also called nadir), as you will most likely be at home during the nadir. For chemotherapy, low counts usually occur 7-10 days after treatment.
Given that neutropenia is caused by cancer treatments, there is not much you can do to prevent it from occurring, but you can decrease the risk of getting an infection while your count is low.
Steps to help prevent infection:
You may receive a growth factor to stimulate neutrophil production. This is a man-made version of a natural hormone that causes the body to produce more neutrophils. It is given by an injection just under the skin. There are a few growth factors available in the United States: filgrastim (Neupogen®), pegfilgrastim (Neulasta®) and sargramostim (Leukine®).
Even the best hand washers end up with an infection. An infection in a neutropenic patient is an emergency! If you notice any signs or symptoms of infection, you should call your doctor right away - even if it is the middle of the night. Make sure you know how to reach someone when the office is closed!
Signs and symptoms of infection to look for:
You may be told to follow a neutropenic diet. This diet is intended to decrease your exposure to bacteria. A basic neutropenic diet includes:
Every cancer center has different rules regarding the neutropenic diet. Be sure to ask your healthcare team for any special instructions. Patients undergoing bone marrow or stem cell transplant will have a stricter diet. Remember this diet is only temporary while your blood counts are low. Wash your hands well before preparing any food and keep your work area clean.
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