Neutropenia Health Article

Special Concerns

Often the infections that develop in a cancer patient are opportunistic infections. That is, the organisms responsible for the infection normally would not cause disease in a healthy person, but do so in a cancer patient because the immune system is weak. Several steps can be taken on a daily basis to reduce the risk of developing an infection.

Steps to Prevent Infection

• Care should be taken to keep the body clean. Hands should be washed after using the bathroom and before eating.
• Avoid stagnant or still water in the environment that might contain bacteria such as flower vases and birdbaths, or containers that may hold items such as dentures.
• Use antiseptic mouthwashes to cleanse the mouth. Use those that do not contain alcohol.
• Use deodorant. Antiperspirants will not allow the body to sweat, trapping bacteria within the body that may increase the risk of infection.
• Women with neutropenia should consider using sanitary napkins instead of tampons during their menstruation to help prevent possible infection such as toxic shock syndrome.
• Avoid others who are ill and large crowded areas where one might encounter illness.
• Avoid activities that may increase the chance of physical injury. Take care to protect the body by wearing gloves, shoes, and other items. Tend to all injuries as soon as possible.
• Neutropenic patients should consult their doctors before receiving any vaccinations.

Treatments

Treatment of neutropenia depends on the underlying cause.

Medications

Patients with fever and other signs of infection are treated with antibiotics. Some antibiotics used in the treatment of cancer patients include imipenem, meropenem, aminoglycoside, antipesudomonal penicillin, rifampin, and vancomycin. Combination therapy can be used that uses several types of antibiotics to stop the infection, but some of the drugs may be toxic or costly.

Patients receiving chemotherapy for cancer may be given drugs even in health to help restore the WBC to normal. A blood growth factor called sargramostim (Leukine, Prokine) stimulates WBC production. Another commonly used medication to reduce neutropenia in cancer patients is the cytokine G-CSF (granulocyte colony-stimulating factor, or filgrastim by Amgen-Roche). This substance is normally produced in the body at low levels. G-CSF helps the body produce more neutrophils to fight infection. This is especially useful in that many bacteria can not be killed by antibiotics due to antibiotic resistance.

Throughout the course of treatment it is important that the patient be monitored closely. This requires hospitalization for some patients, while others may be adequately treated at home.

Alternative and complementary therapies

A healthy lifestyle should be adopted that includes good nutrition, plenty of sleep, and appropriate levels of exercise. Avoid uncooked foods that may contain harmful bacteria. A nutritionist should be consulted to determine an appropriate, healthy diet.

Psychological stress can also weaken the immune system, making a person more susceptible to illness. It is important to find emotional support through family, friends, support groups, or through spiritual means.

See Also Immunologic therapies; Infection and sepsis; Chronic myelocytic leukemia

Resources

BOOKS

Baehner, Robert L. "Neutropenia." In Conn's Current Therapy. Rakel, R., ed. Philadelphia: W. B. Saunders Company, 1998.

"Hematology and Oncology: Leukopenia; Neutropenia." In The Merck Manual of Diagnosis and Therapy, Vol. II. Berkow, R., et al, eds. Rahway, NJ: Merck Research Lab oratories, 1992.

Janeway, Charles A., et al. Immunobiology:The Immune Sys tem in Health and Disease. London and New York: Cur rent Biology Publications, Elsevier Science London/Gar-land Publishing, 1999.

"Infectious Diseases: Neonatal Sepsis." In Neonatology: Man agement, Procedures, On-Call Problems, Diseases and Drugs. Gomella, T.L., et al, eds. Norwalk, CT: Appleton & Lange, 1994.

Lane, Peter A., et al. "Hematologic Disorders." In Current Pediatric Diagnosis & Treatment. Hay, W.W., et al, eds. Stamford, CT: Appleton & Lange, 1997.

Linker, Charles A. "Blood." In Current Medical Diagnosis & Treatment 1998. Tierney, L.M., et al, eds. Stamford, CT: Appleton & Lange, 1997.

Pearson, Starr P., and Stanley J. Russin. "Quantitative Disor ders of Granulocytes." In Current Diagnosis 9. Conn, R.B., et al, eds. Philadelphia: W. B. Saunders Company, 1997.

Physicians'Guide to Rare Diseases. Thoene, J.G., ed. Mont-vale, NJ: Dowden Publishing Company, Inc., 1995.

PERIODICALS

Feld, Ronald. "Vancomycin as Part of Initial Empirical Antibi otic Therapy for Febrile Neutropenia in Patients with Can cer: Pros and Cons." Clinical Infectious Diseases 29 (1999): 503-7

Rahiala, J., Perkkio, M., and Pekka Riikonen. "Prospective and Randomized Comparison of Early Versus Delayed Pro phylactic Administration of Granulocyte Colony-Stimu lating Factor (Filgrastim) in Children With Cancer." Med ical and Pediatric Oncology 32 (1999): 326-30.

Rolston, Kenneth. "New Trends in Patient Management: Risk-based Therapy for Febrile Patients with Neutropenia." Clinical Infectious Diseases 29 (1999): 515-21

OTHER

American Cancer Society. <http://www.cancer.org>

Mayo Clinic. <http://www.mayoclinic.com>

WebMd. <www.webMD.com>

National Neutropenia Network, Inc. <http://www.neutropenia.org>

University of Pennsylvania Oncolink <http://www.oncolink.upenn.edu>

Rebecca Frey, Ph.D.

Jill Granger, M.S.