Neutropenia

A condition in which there are reduced levels of neutrophils (a type of white blood cell) in the blood is called neutropenia. It often occurs in people who get cancer treatments (such as chemotherapy). This type of white blood cell is primarily produced by the bone marrow. Normally, these white blood cells help fight infections, but if you develop neutropenia, it is very important to take extra precautions and avoid germs that can make you ill.

Normal Levels of Neutrophils

This condition is classified by experts as mild, moderate, or severe. It depends on the number of neutrophils in a blood sample. In general, the lowest normal limit for adults is approximately 1,500 neutrophils per microliter of blood by multiple standards. Check the range of neutrophil numbers below:

Mild neutropenia (1,000 to 1,500)
Moderate neutropenia (500 to 1,000)
Severe neutropenia (less than 500)

This condition is also classified as acute (temporary), chronic (long-term), congenital (present at birth), or acquired (in such cases, it occurs over time).

How Does Neutropenia Affect My Body?

The effects of this condition often are different among people who develop it. For instance, in mild cases, people may not even have any symptoms, and it is often found accidentally while performing tests for other reasons. In people with moderate or severe neutropenia, the risk of developing infections significantly increases, and without treatment, it may lead to life-threatening complications.

Symptoms

While mild forms of this condition do not cause symptoms, people with moderate or severe neutropenia may experience the following symptoms. Examples include:

Fever (febrile neutropenia)
Extreme tiredness (fatigue)
Pharyngitis (sore throat)
Swollen lymph nodes
Ulcers in the mouth or around the anus
Diarrhea
Pain, swelling, and rash at the site of infection
Frequent urination or a burning sensation while peeing

If any of the previous symptoms occur, it is advised to see a doctor.

Causes

While this condition may happen when the bone marrow does not produce enough neutrophils, it may also occur when these blood cells are destroyed. Check some causes of neutropenia below:

Genetic disorders – For example, benign ethnic neutropenia (BEN), cyclic neutropenia, and severe congenital neutropenia that are caused by abnormal genes that are passed from the biological parents to their children.
Infections – In general, viral, bacterial, and parasitic infections can cause neutropenia. These include HIV infection, hepatitis, tuberculosis, sepsis, Lyme disease, and others.
Cancer – If you develop cancer of the blood (including lymphoma and leukemia), it may also lead to neutropenia.
Medicines – Neutropenia is a common condition among people who receive cancer treatments (such as chemotherapy or radiation therapy). These treatments destroy neutrophils or negatively affect the bone marrow that eventually produce less white blood cells.
Nutritional deficiencies – If you do not have enough vitamins or minerals (including copper, folate, or vitamin B12), it may also lead to neutropenia.
Autoimmune disorders – There are some autoimmune conditions that can cause neutropenia. For example, Crohn’s disease, lupus, rheumatoid arthritis, and others.

When doctors cannot identify what exactly causes this condition, it is called idiopathic neutropenia.

Why Does Cancer Treatment Cause Neutropenia?

While cancer treatments destroy cancerous cells, they may also affect healthy blood cells (such as neutrophils). That’s why you should avoid infections and take precautions if you get cancer treatments.

What Are The Possible Neutropenia Complications?

People who develop neutropenia and do not get treatment may also experience the following complications. Check some of them below:

Sepsis/septic shock
Opportunistic infections (these are infections caused by fungi or bacteria that are often harmless to people)
Blood cancers, such as myelodysplastic syndromes (MDS) or acute myeloid leukemia (AML)
Skin infections
Pneumonia
Urinary tract infections (UTIs)

The previous list does not contain a complete list of complications. However, you can consult with your doctor about ways to reduce the risk or even prevent them.

How to Prevent Neutropenia?

Unfortunately, it is not possible to prevent all types of neutropenia (such as congenital neutropenia). However, if you receive cancer treatments, you can reduce the dose or change the chemo drug. Sometimes, doctors may also recommend some injections of G-CSF to boost the white blood cell production. Check below some additional precautions that may help prevent infections if you have a moderate or severe neutropenia:

Regularly wash your hands with soap and warm water or use an alcohol-based hand sanitizer
Vaccines – Doctors may recommend shots for the flu and COVID-19.
Avoid sick people and crowded places
Prevent the spread of germs by washing fruits and vegetables. You should also keep the meats away from other foods and prepare them at a safe temperature.
Do not share your utensils, cups, food, drinks, towels, razors, or toothbrushes with other people.
Wear gloves each time you are gardening or working in the yard.
Do not pick up pet waste or change a newborn’s diaper or wash your hands each time after these procedures.
It is also recommended to avoid lakes, ponds, rivers, and hot tubs.
Administer prophylactic medicines exactly as recommended by your doctor. Otherwise, it may lead to unpleasant outcomes.
Avoid injuries, such as scrapes, tears, or cuts, or get wound care immediately if it occurs.

Diagnosis

One of the common tests used to diagnose neutropenia is a type of blood test called a complete blood count (CBC) with differential. Moreover, doctors often perform this test multiple times to monitor neutrophil levels (especially if you receive chemotherapy).

In more severe cases, physicians may perform a bone marrow biopsy. During this procedure, your doctor will take a sample of the bone marrow for testing. They often check for abnormal neutrophils or whether they are destroyed after being produced.

Treatment

While some forms of neutropenia do not need treatment, doctors may recommend the following options for people with moderate to severe neutropenia. Examples include:

Antibiotics – This group of medications is primarily used to treat bacterial infections. Moreover, an antibiotic treatment can save your life if you have febrile neutropenia. However, most people with this type of neutropenia are hospitalized and receive intravenous (IV) antibiotics.
Corticosteroids – These medications are often used to relieve inflammation. Doctors often prescribe them for people with autoimmune disorders. Sometimes, corticosteroids can suppress the immune system and prevent the formation of antibodies that destroy neutrophils.
Granulocyte colony-stimulating factor (G-CSF) – If you receive cancer treatments, doctors may recommend injections with G-CSF that help stimulate the bone marrow to produce more white blood cells.

When medicines you administer cause neutropenia, doctors may reduce the dose or even change the medication.

Frequently Asked Questions

What is the prognosis for people who have neutropenia?

Commonly, the prognosis of this condition is good because it can be treated (especially if you prevent infections). In moderate to severe cases, people may develop serious complications even with treatment. Discuss it with your doctor for more details.

When should I see my healthcare provider?

If you experience any of the following symptoms, immediately visit a doctor. For example:

Sweating and chills
Breathing problems
Diarrhea or vomiting
Vaginal discharge or irritation
Fever
Pain in the abdominal area or rectum
Confusion
Increased fatigue

What causes neutropenia in adults?

In most cases, neutropenia in adults occurs due to bone marrow problems that are often caused by cancer treatments, myelodysplastic syndromes, infections, nutritional deficiencies, or certain medicines (such as antibiotics or antipsychotic medicines). If you have additional questions, ask your healthcare provider.