How to manage neutropenia following cancer treatment?

Blood is composed of red blood cells, white blood cells, plasma and platelets. It is essential to maintain specific levels of these blood cells for the proper functioning of the body. Certain cancers and chemotherapy significantly affect the levels of blood cells in the body, leading to problems such as anaemia and neutropenia. These problems further can cause fatigue, tiredness and weight loss.

Anaemia is a condition of deficiency of red blood cells in the body. It is prevalent among cancer patients. It is the reason doctors prescribe supplementary medications and a planned diet to reduce the risk of anaemia. You can read more about anaemia during cancer here 'Anemia in cancer patients: Are you aware?'

Other than anaemia, cancer patients also suffered from a low number of neutrophils, a type of white blood cells. This condition is referred to as neutropenia. Let's discuss neutropenia, its prevention and management in detail:

What is neutropenia?

Neutropenia is a very common complication of cancer and a side effect of cancer treatments such as chemotherapy and radiotherapy. This condition causes a decrease in neutrophils which are the body's first line of defence against pathogens and infectious agents.

The normal count of neutrophils is from 1500 – 8000 neutrophils/mcL. When cells remain 1000 – 1500, it is considered mild neutropenia, followed by moderate (1000 – 500) and severe neutropenia (lower than 500).

Cancer treatments can destroy neutrophils, thus making your body more susceptible to infectious diseases, illness, and hematologic complications such as bleeding and thrombosis. Therefore, it is essential to be aware of this problem and supportive treatments to maintain good health and adherence to cancer treatment.

How common is neutropenia during cancer?

The majority of patients who have cancer develop neutropenia, most commonly due to chemotherapy. The problem can also be provoked by solid tumour malignancies, which infiltrate the bone marrow. It adversely affects the normal function of bone marrow to produce cells, including white blood cells.

Other than this, neutropenia can be caused due to many lymphoproliferative malignancies like hairy cell leukaemia, chronic lymphocytic leukaemia (CLL), natural killer cell lymphoma or due to radiation therapy.

What is febrile neutropenia?

When the absolute neutrophil count becomes less than 500 cells/mm³and the patient has a temperature of more than 38.5°C (100.4°F), the condition is called febrile neutropenia. Cancer patients with this condition are at a higher risk of getting infections. Bacterial infections are known to be the general cause of mortality and morbidity in neutropenic patients.

What are the signs and symptoms of neutropenia?

• One-time temperature of 101°F/higher or F100.4°F/higher for more than one hour
• Breathlessness
• Sweats and chills
• Stiff neck
• Change in cough and nasal congestion
• Sore throat or new mouth sore
• Swelling or redness in any area
• New onset of pain
• Diarrhoea
• Unusual vaginal discharge
• Pain or burning with urination
• Vomiting

What are the risk factors of neutropenia during cancer?

• Older age
• History of multiple cytotoxic chemotherapy regimens
• Solid tumour malignancies
• Bone marrow transplantation
• Chemotherapy for hematologic malignancies

What are the consequences of neutropenia?

• It increases the risk of bacterial, fungal and viral infections, thus adversely affecting the patient and mortality in immunocompromised neutropenic patients.
• It can delay chemotherapy administration and, subsequently, dose modification. Such things can have long-lasting consequences in the context of disease outcomes among patients being addressed with curative intent rather than in the metastatic setting.
• It can cause neutropenic colitis, also known as typhlitis, another major complication among neutropenic patients. Affected patients were found to have intestinal mucosal injury along with neutropenia and a weak immune system. This condition is managed using antibiotics with conservative therapies. However, patients with ischemic bowel might need surgical management. In addition, patients with hematologic malignancies with prolonged periods of neutropenia more commonly suffer from this condition.

How is neutropenia managed among cancer patients?

Treatment of neutropenia is individualized. Your doctor will decide on a specific treatment depending on the cause and severity of neutropenia. Several approaches used for treating neutropenia include:

• Delaying dose interval or modifying medications in case of drug induced neutropenia.
• Use of antibiotics for reducing fever in febrile neutropenia.
• Hematopoietic growth factors can also be used in the treatment of mild to severe neutropenia.
• Research studies have established that long term treatment with hematopoietic growth factor, recombinant human granulocyte colony stimulating factor (g-csf) can help to increase neutrophil counts to normal range in cancer patients. It can also reduce infection related events such as inflammation, fever, and oral ulcerations. Tbo-filgrastim is the most recently FDA-approved G-CSF. However, the treatment can be individualized.
• Stem cell transplants in very severe and rare cases.

Can neutropenia be prevented in cancer patients?

Neutropenia is unable to prevent; however additional measures can reduce the risk of getting severe infections associated with it in cancer patients. Preventive measures to minimize the risk of infections are:

• Clean and sanitize your hands frequently.
• Shower daily and use unscented soap or lotion to prevent your skin from being dry or cracked.
• Use gloves to do household activities such as cleaning and washing.
• Keep all household surfaces, doors and windows clean and sanitized.
• Don't share your utensils, eatables, personal care products and reusable medical devices such as thermometers with anyone.
• Follow good hygiene practices while cooking food and always prefer to eat cooked food.
• Prevent contact with people who are sick, especially with respiratory infections.
• Avoid contact with animal saliva, urine, faeces, saliva and solid litter box material while caring for pets.
• Get your seasonal flu shot as soon as it is available.
• Take your medication regularly and follow the precautions recommended by your doctor.

Conclusion

Neutropenia is a life-threatening condition with high mortality and morbidity. It needs to be monitored at regular intervals following cancer treatment. Patients themselves should go for regular complete blood counts (CBC) tests and follow-up to monitor their disease status and improvement if any.

If you suspect any signs and symptoms, refer to your health care provider or physician immediately. It will surely help to reduce the risk of neutropenia and associated complications.

Other than problems like neutropenia, fatigue or anaemia, cancer patients also suffer from the condition 'Chemobrain'. Are you aware of this? If not, you can explore this term by clicking here 'Chemobrain: Cognitive impairment in cancer patients.'