Cancer Information

Neutropenia

What is neutropenia?

Neutropenia is a medical condition in which there are not enough white blood cells (neutrophils) circulating in the blood stream. Blood cells are made in the bone marrow which makes three different types of blood cell:

red blood cells which carry oxygen around the body
white blood cells which fight infection
platelets which help blood to clot and prevent bruising.

Neutrophils are a particular type of white blood cells and are an important part of the immune system helping to protect the body against bacterial infections.

Neutropenia can come on suddenly (acute), been there for a long time (chronic) or come and go (cyclic).

What are the causes of neutropenia?

There are many causes of neutropenia. These can include:

an allergic reaction
an infection from a fungus or bacteria
an enlarged spleen
after taking certain medications
problems with your immune system
myelodysplastic syndromes (MDS) or leukaemias.

A common cause of neutropenia is cancer treatment, such as chemotherapy. Chemotherapy uses drugs to kill or slow the growth of cancer cells. All the cells in your body grow by splitting or dividing into two cells. Chemotherapy damages cells that are dividing rapidly such as cancer cells, but also some normal cells such a blood cells, hair follicles and cells inside the bowel, mouth and reproductive organs. Blood cells can, therefore, be damaged by chemotherapy and your blood count (the number of red blood cells, white blood cells and platelets) can be reduced.

Febrile neutropenia

Febrile neutropenia is usually a complication of cancer treatment. It is the development of a fever, alongside other signs of infection such as feeling unwell, shivers and shakes in a patient with neutropenia. If you have a fever of 38°C or higher, you should seek immediate medical attention.

What are the symptoms of neutropenia?

Some people do not have any symptoms of neutropenia but symptoms can include bacterial infections on different parts of the body such as skin, mouth and gums, sinuses or internal organs.

If you had chemotherapy less than six weeks ago or have been told you have neutropenia, you should tell your doctor if you experience any of these symptoms:

sore throat or sores in the mouth
toothache
sweating or chills
pain in the anal region
pain or burning when urinating
diarrhoea
cough or shortness of breath
unusual vaginal discharge
a rash or swelling on your skin.

How is neutropenia diagnosed?

Neutropenia is diagnosed by taking a blood test to check your blood count. You may need to have more than one blood test and in some cases a bone marrow test may be needed.

How is neutropenia treated?

Treatment for neutropenia will depend on the cause and how severe it is. Mild cases may not need any treatment.

If you are having chemotherapy, you will have blood tests at the beginning of treatment and before each cycle to check your blood count is adequate. If your blood count is low, your treatment team may delay the next round of chemotherapy or reduce the dose. You may also be given granulocyte colony stimulating factor (GCSF) injections to help the body make more neutrophils. Antibiotics, antivirals and/or antifungals may also be recommended to reduce the risk of infection.

Febrile neutropenia is a serious condition and should be treated immediately with antibiotics.

What are the risks associated with neutropenia?

The main risk associated with neutropenia is increased risk of infection. If you have been diagnosed with neutropenia you should practice good personal hygiene to reduce your risk of infection. This can include: