Chemotherapy works by killing cancer cells in your body. Unfortunately, it also kills healthy cells including both red and white blood cells. White blood cells are important in preventing and fighting infection. Neutropenia is a disorder that occurs when your white blood cells drop below a certain level, putting you at a higher risk of a life threatening infection.
The risk of neutropenia varies depending on which chemotherapy drugs you receive. Neutropenia is most likely to occur 10 to 14 days following your treatment. Your healthcare provider will draw blood to check your white cell count prior to each treatment to determine if it’s safe to give your chemotherapy
A drug called filgrastim or Neulasta may be given after each chemotherapy session to help prevent neutropenia.
How Can I Protect Myself Against Infection?
Infection can be one of the most serious complications of cancer and its treatment. It’s important that you take measures to avoid infection. It’s also important that you recognize signs and symptoms of infections and to contact your healthcare team right away if you think you might have an infection.
- Wash up. Wash your hands frequently and take showers regularly. Keep household surfaces clean.
- Avoid exposure. Avoid crowded places and close contact with people who are sick. Don’t share food, dishes, or other personal items.
- Handle food carefully. Wash fruits and vegetables well. Thaw foods in the refrigerator or microwave, not at room temperature. Make sure meat, eggs, and fish are sufficiently cooked. Maintain foods at their proper temperature and refrigerate leftovers right away. When eating out, avoid salad bars and buffets.
- Wear gloves. Protect your hands from direct contact when gardening or handling pet waste.
- Get your flu shot. Get vaccinated early in the season. Most other vaccines aren’t recommended for people with cancer. Ask your doctor which vaccines may help you.
What Signs of Infection Should I Look For?
If you’re neutropenic, even a minor infection can become serious and life threatening. Having a fever is one of the most worrisome signs of infection. Always contact your healthcare team if you develop a fever during your chemotherapy treatment. You’ll likely need to be hospitalized and receive intravenous antibiotics until your white blood cell count returns to normal.
According to the American Cancer Society, a fever is defined as a temperature of 100.5° F or more. Check your temperature if you’re feeling warm, have chills, body aches, or have a sore throat, cough, urinary symptoms, or unusual fatigue. You should also check your temperature if you experience any pain, redness, or swelling especially in an area where there has been trauma like a cut or scrape, IV insertion, or a surgical wound.
Use a thermometer to monitor your temperature. You may have different cultural understandings about fevers and how to manage them. If you have any questions or special concerns, talk with your healthcare team about them in advance.
What Should I Do if I Have a Fever?
A fever in someone with neutropenia, also called neurtropenic fever, should be treated as a medical emergency. The Centers for Disease Control recommends calling your doctor if your temperature is 100.4° F or higher for an hour or more. If your temperature reaches 101° F or higher, call your doctor right away. If you’re not able to reach your doctor go to the emergency department immediately.
Keep yourself comfortable and well hydrated. Take fever-lowering medications only at the advice of your healthcare provider.
If you need to go to the emergency room, let someone at check-in know that you’re undergoing chemotherapy. The Centers for Disease Control says you should avoid sitting in a waiting room for long periods of time.
What if I Have an Infection?
Bacteria, viruses, or fungi can cause infection. Your healthcare team will attempt to find the source of your infection and may order blood cultures, a chest X-ray, urine culture, lumbar puncture, and other blood tests. If you’re neutropenic and have a fever, you’ll be admitted to the hospital and receive broad-spectrum IV antibiotics. You may also receive medication to help boost your white blood cells. If a source of infection is identified, you’ll be treated with appropriate antibiotics, antivirals, or antifungal medications. In some cases of neutropenic fever, no source of infection is identified but you’ll remain in the hospital until you no longer have a fever and your white blood cells return to normal.