How is neutropenia diagnosed?
Neutropenia is diagnosed by a blood cell
count performed on a sample of blood removed
from a vein. To determine the specific cause
of neutropenia in a given situation, other
tests may be required. Sometimes a bone
marrow biopsy may be required to diagnose
the specific cause of neutropenia.
How is neutropenia treated?
Treatment of neutropenia is based upon
the underlying cause, severity, and the
presence of associated infections or
symptoms as well as the overall health
status of the patient. Obviously, treatment
must also be directed toward any underlying
disease process. Treatments that directly
address neutropenia may include (note that
all of these treatments may not be
appropriate in a given setting)
- antibiotic and/or antifungal
medications to help fight infections;
administration of white blood cells
growth factors (such as recombinant
granulocyte colony-stimulating factor
(G-CSF, filgrastim) in some cases of
severe neutropenia;
- granulocyte transfusions; or
corticosteroid therapy or intravenous
immune globulin for some cases of
immune-mediated neutropenia.
Preventive measures may also be
implemented in neutropenic patients to limit
risk of infections.
Cancer & Neutropenia
Neutrophils and other types of white
blood cells are made in the bone marrow (a
spongy tissue found inside larger bones such
as the pelvis, vertebrae, and ribs) and then
circulate in the bloodstream. Cancer and
cancer treatment can cause neutropenia in
several ways:
- Some types of chemotherapy can cause
the bone marrow to not work properly,
lowering the production of neutrophils.
Cancers that affect the bone marrow
directly, including leukemia, lymphoma,
and myeloma, or metastatic cancer
(cancer that has spread) can crowd
normal bone marrow cells.
Radiation
therapy can also affect the bone marrow,
especially if given to several areas of
the body or to bones in the pelvis,
legs, chest, or abdomen.
People with cancer who are age 70 or
older or people with a weakened immune
system (due to factors such as HIV infection
or a kidney transplantation) are at higher
risk for neutropenia. People with severe or
long-lasting neutropenia are more likely to
develop an infection.
Signs and symptoms
Neutropenia itself does not cause any
symptoms. Patients usually find out they
have neutropenia from a blood test or when
an infection develops. Because neutropenia
is a common side effect of some types of
chemotherapy, the doctor will do regular
blood tests, usually a complete blood count
(CBC), to look for neutropenia and other
blood-related complications of chemotherapy.
For patients with neutropenia, even a
minor infection can quickly become serious.
Talk with your doctor right away if you
experience any of the following signs of
infection:
- A fever (temperature
of 101 degrees Fahrenheit or higher)
Chills or sweating
A sore throat or
sores in the mouth
Abdominal pain
Diarrhoea or sores around the anus
Pain or burning when urinating or
frequent urination
A cough or
breathlessness
Any redness, swelling,
or pain, especially around a cut, wound,
or an intravenous (IV) catheter site
Unusual vaginal discharge or itching
Management and treatment
Depending on the type or dose of
chemotherapy, neutrophil counts generally
start to drop about a week after each round
of chemotherapy begins and usually reach a
low point (called the nadir) about seven to
14 days after treatment. A person is most
vulnerable to infection at this point. The
number of neutrophils then starts to rise
again as the bone marrow resumes normal
production of neutrophils, however; it may
take three to four weeks to reach a normal
level. When the neutrophil level returns to
normal, another round of chemotherapy can
begin. If the patient develops neutropenia
or the neutrophil level does not return to
normal quickly enough, the doctor may delay
the next round of chemotherapy or recommend
a lower dose. Sometimes the doctor will
recommend antibiotics during periods of
prolonged neutropenia to try to prevent
infections from occurring.
If chemotherapy causes neutropenia with a
fever, the doctor may decide to use
medications called white blood growth
factors during subsequent cycles of
chemotherapy. These include filgrastim (Neupogen),
pegfilgrastim (Neulasta), or sargramostim (Leukine
or Prokine). These drugs help the body make
more neutrophils or other types of white
blood cells.
want to know more? read
the facts and information about cancer
treatment, risk analysis and neutropenia
management at
American Society of Clinical Oncology's
website
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