Neutropenia

Approved by the Cancer.Net Editorial Board, 10/2016

With neutropenia, the body has a low level of neutrophils. Neutrophils are a type of white blood cell. White blood cells help the body fight infection. They are made in the bone marrow. Bone marrow is the spongy tissue found inside larger bones.

Neutrophils fight infection by destroying organisms that cause infection. These include harmful bacteria and fungi or yeast. This means that people with neutropenia have a higher risk of developing serious infections. People with very low levels of neutrophils or neutropenia that lasts a long time may be more likely to develop infections.

Neutropenia occurs in about half of people with cancer who receive chemotherapy. And, it is a common side effect in people with a certain type of cancer called leukemia.

Signs and symptoms of neutropenia

Some people with neutropenia will feel fatigue. However, neutropenia may not cause any symptoms. Patients usually find out they have neutropenia from a blood test. Or when an infection develops. As a result, your doctor will schedule regular blood tests. These can diagnose neutropenia and other blood-related side effects of chemotherapy.

For patients with neutropenia, even a minor infection can quickly become serious. Signs of infection:

  • A fever, which is a temperature of 100.5°F or higher

  • Chills or sweating

  • Sore throat, sores in the mouth, or a toothache

  • Abdominal pain

  • Pain near the anus

  • Pain or burning when urinating or frequent urination

  • Diarrhea or sores around the anus

  • A cough or shortness of breath

  • Redness, swelling, or pain, particularly around a cut, wound, or catheter placement

  • Unusual vaginal discharge or itching

Infections are treatable. However, left untreated, they can be serious and life-threatening. Talk with your doctor if you experience any of these signs. Also, be sure to mention any changes in your symptoms.

Causes of neutropenia

Factors related to cancer and cancer treatment that can cause neutropenia:

  • Some types of chemotherapy

  • Cancers that affect the bone marrow directly, such as leukemia, lymphoma, and myeloma

  • Cancer that has spread

  • Radiation therapy to several areas of the body or to bones in the pelvis, legs, chest, or abdomen

People with cancer who have a higher risk of developing neutropenia:

  • People age 70 or older

  • People with a lowered immune system from other causes, such as human immunodeficiency virus (HIV) infection or organ transplantation

Common cycle of chemotherapy-related neutropenia

The type or dose of chemotherapy affects when neutrophil levels drop. Generally, they start to drop about a week after chemotherapy begins. Neutrophil levels reach a low point about 7 to 14 days after treatment. This low point is called the nadir. At the nadir, you are most likely to develop an infection.

Your neutrophil count then starts to rise again. This occurs when your bone marrow resumes normal production of neutrophils. However, it may take 3 to 4 weeks to reach a normal level again. At that point, your body is ready for the next round of chemotherapy. If you have had several rounds of chemotherapy, it may take longer for your body to start making healthy levels of neutrophils.

Managing and treating neutropenia

Treatment to relieve symptoms and side effects is an important part of cancer care. This approach is called supportive or palliative care. Talk with your health care team about any symptoms or changes in symptoms that you experience.

If you have neutropenia, take steps to prevent infection. For example, avoid being around people who have a cold, flu, or other illness. Wash your hands frequently, especially before eating and after using the restroom. Learn other steps to avoid infection. During periods of prolonged neutropenia, your doctor may recommend antibiotics to prevent infections.

In addition, neutropenia may affect your next round of chemotherapy. Particularly if your neutrophil level doesn’t return to normal quickly enough. Your doctor may postpone chemotherapy or lower the dose.

For neutropenia with a fever, your doctor may prescribe white blood cell growth factors. These drugs help the body make more white blood cells. Read more about ASCO’s guideline on white blood cell growth factors.

More Information

Side Effects

Side Effects of Radiation Therapy

Side Effects of Chemotherapy

Additional Resources

CDC: Infection and Neutropenia

Lab Tests Online: White Blood Cell Count and White Blood Cell Differential