Neutropenia

Overview

What is neutropenia?

Neutropenia refers to lower-than-normal levels of neutrophils in the blood. A neutrophil is a type of white blood cell that is produced mainly in the bone marrow. White blood cells in general, and neutrophils in particular, are important for infection control in the body.

Neutropenia can be classified as mild, moderate, or severe, depending on the number of neutrophils in a sample of blood. By many standards, the lowest acceptable limit for adults is about 1,500 neutrophils per microliter of blood. (Some put the cut-off at 1,800 per microliter.) The range of neutrophil numbers in mild neutropenia is 1,000-1,500; the number in moderate neutropenia is 500-1,000; and the count in severe neutropenia is less than 500.

Neutropenia can also be classified as acute (temporary or short-lasting) or chronic (long-lasting), congenital (a condition one is born with) or acquired (a condition that happens over a period of time).

Who is affected by neutropenia?

Neutropenia can happen to anyone. It sometimes results from an infection, but it is also often a result of treatment for cancer. It is estimated that 50 percent of the people who get chemotherapy will develop neutropenia.

Some ethnic groups may have neutrophil counts in the 1,200 range that are considered normal for them.

Symptoms and Causes

What are the causes of neutropenia?

Neutropenia happens for one of these reasons: the neutrophils are used up or destroyed faster than they are produced, or the bone marrow does not make enough neutrophils in the first place. There are many factors that fall into these two categories.

Neutropenia can be caused by:

What are the symptoms of neutropenia?

Neutropenia, especially in its mild form, may not have symptoms. If symptoms exist, they could include:

  • Fever
  • Sores
  • Swelling
  • Repeated infections

Diagnosis and Tests

How will a doctor diagnose neutropenia?

The most common test is a simple blood test known as a complete blood count. In some cases, such as when a certain disease is suspected, the doctor might want to test your bone marrow.

Management and Treatment

What are the treatments for neutropenia?

Some types of neutropenia might require no treatment. However, in the case of neutropenia with fever (febrile neutropenia), treatment is necessary. Your doctor will prescribe drugs to fight the infection, such as antibiotics. If you do develop febrile neutropenia, your doctor is likely to admit you to the hospital. You may get your antibiotics intravenously (through a vein). Treating this type of neutropenia is important. Not treating febrile neutropenia could result in death.

If neutropenia is caused by medication, your doctor might tell you to stop the medication. If the cause is an underlying disease, that condition must be treated (as in the case of a vitamin deficiency). Your doctor might prescribe corticosteroids if you have an autoimmune disorder.

Your doctor might also prescribe drugs that promote the production of white blood cells. These drugs, usually given as shots are called growth factors, or colony-stimulating factors.

Prevention

How can you prevent neutropenia?

In general, it is not possible to prevent neutropenia, especially the types that you are born with. However, if you are having chemotherapy, your doctor may suggest getting injections of growth factors to promote white blood cell production. In addition, chemotherapy dosages could be delayed, or the timing changed.

How can you prevent infections if you have neutropenia?

Preventing infections if you have or are liable to develop neutropenia is key. These suggestions should help:

  • Wash your hands frequently with soap and water. Wash your hands before and after you eat, after you use the toilet, after touching pets or things outside of your house, and after you cough or sneeze.
  • Keep and use an alcohol-based hand sanitizer with you when you leave the house.
  • Make sure you get the flu shot as early as you can, if your doctor says you can do this.
  • Stay away from crowds of people and people who are sick.
  • Do not share eating utensils, cups, food or beverages with other people.
  • Do not share towels, razors or toothbrushes with other people.
  • Wash raw fruits and vegetables.
  • Keep raw meats, fish and poultry away from other foods.
  • Use hot water and soap to clean the kitchen surfaces before you start cooking.
  • Cook foods completely to the proper temperature.
  • Use gloves if you are gardening in the dirt or working in the yard.
  • It is best to not pick up pet waste. If you have to do so, use gloves. Wash your hands when you are done.
  • Use a soft toothbrush to brush your teeth at least two times per day.
  • Take a shower each day. Use lotion so your skin does not dry out and crack.
  • Eat a healthy diet.
  • Tell your doctor if you might need dental work so he or she can prescribe antibiotics before the work is done, if necessary.
  • Do not get body piercings or tattoos.
  • Do not swim in lakes or ponds.
  • Avoid becoming constipated if you can.

Outlook / Prognosis

What is the prognosis (outlook) for patients who have neutropenia?

Neutropenia can be treated, so the outlook is good for most patients. Treating and stopping the infection that might occur is very important.

Living With

When should I call the doctor about neutropenia?

If you are receiving chemotherapy, or have any condition that makes you vulnerable to neutropenia, call your doctor immediately if you:

  • Have a fever higher than 100.4 degrees Fahrenheit or 38 degrees Celsius
  • Have trouble breathing
  • Have diarrhea
  • Have soreness, redness or swelling in any part of the body
  • Are sweating or have chills
  • Develop a new cough or your cough gets worse
  • Have any issues with urination: pain, burning, or increased urination
  • Have a sore throat or stiff neck
  • Have vaginal discharge or irritation
  • Have nasal congestion
  • Have pain in the abdomen or the rectum, or any type of new pain
  • Have begun vomiting
  • Feel confused or feel mentally different than usual

Resources

Are there resources for people with neutropenia?

Yes. These organizations include:

Last reviewed by a Cleveland Clinic medical professional on 02/05/2019.

References

  • Damon LE, Babis Andreadis C. Damon L.E., Babis Andreadis C Damon, Lloyd E., and Charalambos Babis Andreadis.Blood Disorders. In: Papadakis MA, McPhee SJ, Rabow MW. Papadakis M.A., McPhee S.J., Rabow M.W. Eds. Maxine A. Papadakis, et al.eds. Current Medical Diagnosis & Treatment 2019 New York, NY: McGraw-Hill.
  • Centers for Disease Control and Prevention. Accessed 2/12/2019.Cancer Prevention and Control: Cost of Cancer-Related Neutropenia or Fever Hospitalizations. (https://www.cdc.gov/cancer/dcpc/research/articles/neutropenia.htm)
  • Patel K, West HJ. . JAMA Oncol. 2017;3(12):1751. Accessed 2/12/2019.Febrile Neutropenia (https://jamanetwork.com/journals/jamaoncology/fullarticle/2645851)
  • Gupta, A, Wolfe, HR, West H(J). JAMA Oncol. 2018;4(9):1307. Accessed 2/12/2019.I Have Neutropenia—What Do I Need to Know? (https://jamanetwork.com/journals/jamaoncology/fullarticle/2694880)
  • Merck Manual Consumer Version. Accessed 2/12/2019.Neutropenia. (https://www.merckmanuals.com/home/blood-disorders/white-blood-cell-disorders/neutropenia)
  • Dale DC. . Curr Opin Hematol. 2016;23(1):1-4. Accessed 2/12/2019. How I diagnose and treat neutropenia (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4668211/)
  • Genetics Home Reference. Accessed 2/12/2019. Severe congenital neutropenia. (https://ghr.nlm.nih.gov/condition/severe-congenital-neutropenia)
  • Centers for Disease Control and Prevention. Accessed 2/12/2019. What You Need to Know: Neutropenia and risk for infection. (https://www.cdc.gov/cancer/preventinfections/pdf/neutropenia.pdf)
  • Gibson C, Berliner N. . Blood. 2014;124(8):1251-8. Accessed 2/12/2019.How we evaluate and treat neutropenia in adults (http://www.bloodjournal.org/content/124/8/1251?sso-checked=true)

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