How to Deal With Neutropenia During Chemotherapy

woman having Chemotherapy

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White blood cells are important components of the immune system which help the body fight infection. When faced with cancer, the immune symptom can often become impaired, resulting in the loss of these cells and an increased vulnerability to infection.

A type of white blood cell commonly affected is known as a neutrophil. Neutrophils are the most plentiful of these defensive cells and are central to the innate immune system. They serve as the body's first-line defense against infection, holding them at bay until the adaptive immune system can kick in.

Neutropenia is a condition characterized by abnormally low neutrophil levels. If levels fall excessively, neutropenia can leave you exposed to an ever-widening range of illnesses and make recovery from treatment all the more difficult.


Neutropenia can be caused both by cancers (such as lymphoma, leukemia, or myeloma) and the very drugs used to treat cancer.

With certain types of cancer, neutrophil production can be affected by malignancies that develop in the bone marrow itself. Bone marrow is chiefly responsible for producing white blood cells, and, if a tumor develops, it can cause levels to drop dramatically. Other types of blood cancer affect neutrophils directly.

Chemotherapy drugs can have much of the same effect. They work by targeting and destroying fast-replicating cells like cancer. Unfortunately, they can also kill other fast-replicating, healthy cells, including hair and blood marrow.

By suppressing bone marrow activity, chemotherapy drugs will commonly cause neutropenia, albeit at varying levels. It usually occurs seven to 12 days after treatment begins and may persist for the duration of therapy. Once chemo is completed, bone marrow function will gradually improve and lead to the normalization of white blood counts.


Most doctors will often take a watch-and-wait approach when dealing with chemo-related neutropenia. However, if your risk of infection is high, your doctor may prescribe a type of drug known as granulocyte colony stimulating factor (G-CSF). Commonly referred to as bone marrow stimulants, the drugs are delivered by injection and, as their name implies, stimulate the production of healthy white blood cells.

These include such options as Neulasta (pegfilgrastim), Neupogen (filgrastim), and Leukine (sargramostim). Depending on the drug used, you may require as few as one injection per infusion course or be given a daily shot until your white blood cell count is up again.

In addition, prophylactic medications may be prescribed to help you avoid infection. These include antibiotics used to prevent bacterial infection and antivirals used to prevent viral infection.

Preventing Infection

While there is often not much you can do to prevent neutropenia during chemo, there are ways to decrease your risk of infection if your levels begin to drop. Among them:

  • Wash your hand several times a day with hot water and soap
  • Keep bathroom, kitchen, and nursery surfaces clean and free from contamination
  • Avoid large crowds
  • Keep away from anyone who is sick and has recently been sick, including family members
  • Clean and bandage any cuts or scrapes
  • Maintain good oral hygiene
  • Do not share utensils, towels, lipstick, or personal care items
  • Wear gloves when working in the garden
  • Do not clean litter boxes or bird cages
  • Cook meat, poultry, or fish well
  • Avoid raw fish or meat, including sushi or carpaccio
  • Wash all fruits and vegetables before eating them
  • Avoid rectal suppositories or enemas
  • Avoid constipation
  • Use sanitary napkins instead of tampons
  • Avoid douching or bubble baths which may disturb your vaginal biome
  • Ask your doctor about immunizations, including ​flu shots

Finally, it is important that you have a good thermometer on hand so that you can detect a fever early. If undergoing chemo, always treat a fever as an emergency and contact your doctor immediately in the event you may have gotten an infection.

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Article Sources

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  • Yarbro, C.; Wujcik, D.; and Holmes Gobel, B. (2010) Cancer Nursing: Principles and Practice (7th ed.) Sudbury, Massachusetts: Jones and Bartlett. ISBN-13: 978-0763763572.