Understanding neutropenia during chemotherapy
Hester Hill Schnipper, LICSW, OSW-C Program Manager Emeritus, Oncology, Social Work
DECEMBER 31, 2019
When you are told that you need chemotherapy to best treat your cancer, it is likely that your immediate worries included hair loss and nausea. Although enormous progress has been made in the development of drugs to manage nausea and vomiting during cancer treatment, most people are very concerned about the possibility. I remember when we handed patients small plastic basins as they left the Infusion Area; it was likely that the vomiting would begin before they got home. Blessedly, times are very different, and most patients never vomit and may even rarely experience nausea or an unsettled stomach. It would be nice if the same improvement could be demonstrated for hair loss. In spite of cold caps and their value with some drugs, many men and women do end up losing their hair from chemotherapy.
An extremely common, almost universal, possible side effect of chemo is neutropenia: a low level of neutrophils, a type of white blood cell. Chemo kills fast growing cells, so this explains why the drugs often kill new blood cells. When you have your blood counts checked during chemo, this is one of the main things being examined. Neutrophils fight infections by destroying potentially harmful bacteria and fungi that can invade our bodies. They are made in our bone marrow, and are a critical part of our bodies' attempts to keep us healthy. Depending on the kind of chemo drugs being used, you may have a greater of lesser risk of developing neutropenia, a too low white blood count, but about half of chemo patients have some level of lowered white counts.
Unless and until you get sick, neutropenia does not cause symptoms. You may feel more fatigued when your counts are low, but that is easily overlooked, as almost everyone going through chemotherapy is more tired than usual. Generally, patients discover that they have neutropenia from a routine blood test when they get an infection. Our doctors worry a lot more about this risk than they do about our hair loss. When your immune system is compromised, you can get very sick, very quickly.
You always receive careful instructions about when to call. These include a temperature of over 100.5, a sore throat, earache or other symptoms, chills, sweating, and pain. If you call your doctor to report any of these issues, no matter the time of day or night, you may well be told to go immediately to the ER. This is no time to loiter. If you are given this order, get yourself to the ER right away. You will be put immediately on IV antibiotics and possibly hospitalized for a few days. Although a fever of 100.5 may not seem alarming in the normal course of things, it is potentially a sign of catastrophe for someone with too low blood counts.
Yes, I am trying to scare you a little. But there is another perspective, too. Sometimes people are unnecessarily worried about their blood counts and potential exposure to infections. Your doctors will carefully monitor your blood counts and will tell you when you have to avoid crowds and exercise caution. Most of the time, our counts are lowest 7-14 days after treatment; this is called the nadir. Ideally, it would be wise to stay off airplanes and away from other closed crowded public spaces during this period, although it may not be necessary. It certainly is not necessary to stay home for the duration of your chemo treatment, avoiding all people and situations. If you have heard about cancer patients who were asked to do so, there was more to their stories. For example, people discharged home after bone marrow transplants have rigid rules about avoiding exposure. Most of us do not have those same restrictions.
Since we don't have control over our blood counts, the best advice is of the common sense variety. Wash your hands frequently and keep them away from your face. If you know someone is ill, it would be smarter not to be in his or her close company. Don't share cups or forks with others. Most importantly, listen to your doctors when they tell you when to call in, when to go to the ER, and when not to worry.
Have you had to contend with neutropenia? Have you worried about exposure to germs? Join the BIDMC Cancer Community and share your story.