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Neutropenia due to Bone Marrow Suppression

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What is Neutropenia?

Neutropenia refers to a low Neutrophil count. A Neutrophil is a special type of White Blood Cell (WBC) that fights bacterial infections. All WBCs fight infections, but Neutrophils are especially important. White Blood Cells, including Neutrophils, are made in the bone marrow. Some chemotherapy affects the body’s ability to make white blood cells. When the bone marrow is suppressed, for example from chemotherapy, it can lower the number WBCs which increases the person’s risk for infection. The body’s infection-fighting ability is measured by two numbers: WBC Count and Absolute Neutrophil Count (ANC). The ANC is a number determined by the percentage of WBCs that are neutrophils. It is the guideline most often used to tell us how well the body can fight infection.

Ranking ANC according to risk of infection:

Greater than 1000 - Normal risk of infection

500 – 1000 - Moderate Risk of infection

Less than 500 - Severe Risk of infection

Signs and Symptoms of Infection:

  • Fever- a temperature of : 100.4 0 Fahrenheit (38 0 Celsius) or greater taken on two occasions at least one hour apart, OR One temperature of 1010 F (38.30 C) or greater in a 24 hour period, OR The temperature your doctor tells you to report: ___________________________________________
  • Shaking, chills
  • Irritability/crankiness/sluggishness • Mouth sores and oral sensitivity
  • Pain or tenderness around rectal area
  • Eye drainage
  • Persistent cough
  • Change in stools (diarrhea)  
  • Persistent vomiting (vomiting more than once and inability to take and retain fluids)
  • Areas of skin redness, pain, drainage, especially around any open areas such as the CVL.
  • No fever, but your child has a noticeable change in behavior (not acting like himself/herself)

Precautions to Take at Home to Prevent Infection

  • Be aware of your child’s ANC and when he/she is more at risk for infection.
  • Use very good hand washing (especially before and after meals, and after using the bathroom).
  • Good personal hygiene: Daily bathing with attention to skin folds; thorough cleaning after using the bathroom.
  • Avoid large crowds in a closed environment choose non-busy hours for malls, theaters).
  • At home, masks are not necessary unless your doctor tells you to wear one.
  • Even if your child’s ANC is below 500, if they feel well and have no other symptoms it is safe to attend school in most circumstances.  Check with your doctor who knows your child’s risk of infection best.
  • Avoid contact with people who are sick or have a fever:
    • colds with fever
    • Flu
    • Chicken Pox
    • Vomiting or diarrhea
  • Always wear foot coverings when outdoors to protect feet from injury.
  • Take all prescribed medications.
  • Eat only well-cooked meats and eggs.
  • Do not clean or touch kitty litter, or other animal waste.
  • Cleanse all cuts and scrapes with soap and water. Do not leave bandage on longer than 12 – 24 hours.
  • Adolescent females should avoid the use of tampons during menstrual flow and use pads only.
  • Good oral hygiene after meals and at bedtime:
    • Use only soft toothbrushes
    • If an oral rinse has been ordered such as Biotene, swish and spit after brushing.
    • It is very important to use Nystatin or Mycelex after cleansing mouth, but remember nothing to eat or drink for ½ hour after taking it.
    • Flossing should continue unless gums are bleeding or have open sores. Ask your doctor about flossing if your child’s platelet count is low.
  • Good nutrition is important to maintain throughout periods of neutropenia. Please speak with the nutritionist for diet suggestions if needed.
  • Offer frequent high calorie, high protein meals and snacks. Possible extra snacks include:
    • Milkshakes
    • Carnation Instant Breakfast

When to Call Your Child's Doctor:

  • If your child has a fever as listed on page 1, call the clinic or doctor on-call immediately.
  • Shaking, chills Exposure to chicken pox – call as soon as you learn of exposure
  • Mouth sores interfering with ability to drink
  • Rectal pain, bleeding, or tenderness
  • Redness or drainage at CVL site
  • There are several factors your doctor will consider if your child has fever and neutropenia. In most instances, if your child has a fever with an ANC less than 500, he/she will be admitted to the hospital and treated with IV antibiotics.

Disclaimer: This information is not intended to substitute or replace the professional medical advice you receive from your child's physician. The content provided on this page is for informational purposes only, and was not designed to diagnose or treat a health problem or disease. Please consult your child's physician with any questions or concerns you may have regarding a medical condition.

Reviewed: 11/2009

(757) 668-7000