White blood cells help your body fight off infection. Strong chemotherapy (chemo) can lower your white blood cell count. When your body doesn't have enough of a type of white blood cell called the neutrophil, the condition is called neutropenia.

Normal Blood Cell Count vs Low Blood Cell Count

Before strong chemotherapy: With strong chemotherapy:
White blood cells are a key part of your immune system. At natural levels, white blood cells help protect your body against infection. Strong chemotherapy can lower the number of infection-fighting white blood cells in your body, which may weaken your immune system and increase your risk for certain types of infection.

Cancer patients who have neutropenia have a greater risk of infection.
Your risk increases when your white blood cell count gets low and stays low for a long time.

Your doctor and care team will keep close track of your white blood cells during strong chemo. Talk with your doctor and care team about symptoms you may have when your white blood cell count is low and when you should notify them.

Signs of Infection

Fever may be the first and only sign that you have an infection. Since strong chemo that also lowers your white blood cell count may increase your risk of getting an infection, you should check your temperature according to your doctor's recommendations.
Neutropenia with fever is referred to as febrile neutropenia.

Watch for Signs of Infection
Fever (temperature of 100.5° F or higher)Urinary burning or urgency
ChillsUnusual vaginal discharge or itching
Cough or sore throatRedness, swelling, or sores on skin
DiarrheaShortness of breath/chest pain
Mouth ulcers or sores in the throat or around the rectumStomach pain
Vomiting that continues for more than 12 hoursBlood in urine

If your temperature is higher than 100.5° F, contact your doctor right away to ask if you need to be seen. If your temperature is high and you experience other signs and symptoms of infection, you can also go to the nearest emergency room.

Who's at Additional Risk?

Some patients in certain situations or receiving certain treatments may be most at risk for febrile neutropenia, including:

  • You are 65 or older.
  • You previously developed a low white blood cell count while being treated with strong chemo.
  • You already have a low white blood cell count while being treated with strong chemo.
  • Your cancer has spread to your bone marrow.
  • You've had strong chemotherapy or radiation before.
  • You have medical conditions like diabetes or liver or heart diseases.

Be Proactive

Infections can be a serious threat to your health. Be proactive. Speak with your doctor and care team about how to reduce your risk of infection during strong chemo.

You can also take a few simple steps to help protect yourself:

  • Wash your hands often and use hand sanitizer when you can't use soap and water.
  • Avoid people with colds or the flu. Stay away from large crowds. These steps can help reduce your chance of coming into contact with someone who is sick.
  • Bathe regularly. Be careful to dry your skin completely.
  • Use an electric razor instead of a blade. This may help you to avoid cuts.
  • Use unscented lotion to help prevent cracks in your skin. Open cuts and cracks may let bacteria in.
  • Clean cuts and scrapes right away with warm water and soap. Then, cover the area with a clean bandage.
  • Cook all food thoroughly. This will help kill any potential germs that may be on raw food. Ask your doctor about how to enjoy fresh fruits and vegetables safely.

Ask Your Doctor:

  • Is my cancer being treated with strong chemo that can put me at risk for low white blood cells?
  • What will you look at to determine whether I have neutropenia caused by strong chemo?
  • Am I at special risk for infection?
  • What are the signs of infection?
  • How long will I be at risk for infection?
  • What should I do if I have a fever?
  • What should I do to help prevent infection?

 Print this worksheet 
 and bring it to your next doctor's visit.

A Closer Look: Glenn*
Glenn is on a strong chemo plan. It is known to be myelosuppressive, which means it affects the bone marrow activity that creates new blood cells.
Glenn goes to his treatments and does everything he's told, but he doesn't feel comfortable asking a lot of questions.
Soon into his first cycle of chemo, Glenn spikes a high fever and gets violent chills.
Alarmed, he calls his doctor right away. He is taken to the hospital in an ambulance.
Blood tests show that Glenn has a very low neutrophil count. He is diagnosed with febrile neutropenia (low white blood cell count with fever).
Glenn is found to have an infection. He is treated with intravenous antibiotics in the oncology unit of the hospital.

*This is a fictional case study based on strong chemo patient experiences. Your experience is unique. Your doctor and care team will create a plan that will best treat your type of cancer and manage your strong chemo side effects.

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