Chemotherapy-induced neutropenia (CIN) could put the patient at risk of some life-threatening infections. This condition could be reduced by reducing the dose of the drug or frequency. However, it would compromise or even adversely affect the treatment result.

Neutropenia is a condition wherein the white blood cells or neutrophils in the blood decrease in number. These white blood cell strengthen our immune system. Hence, reduction in the number of these cells makes our body susceptible to infections as it directly decreases our immunity.

One of the major side effect of chemotherapy drugs is neutropenia. As these drugs attack the healthy cells in the bone marrow and other fast dividing cells along with the cancer cells, it can reduce the white blood cell count in the patient’s body, thus causing neutropenia. Hence, it is essential to do a CBC or a complete blood count before every cycle of chemotherapy to check each of the cell count.

Normal Counts and ANC

The normal total white blood cell count usually ranges from 4000 to 10000 cells per cubic millimeter. However, prior to chemotherapy an absolute blood count would be considered appropriate to start the drug infusion. This absolute neutrophil count or ANC is relatively lower than the normal total white cells count.

An acceptable ANC ranges from 2500 to 6000 neutrophils per cubic millimeter.

There are 3 degrees of neutropenia:

• ANC of 1000 to 1500 - mild risk of infection
• ANC of 500 to 1000 - moderate risk of infection
• ANC less than 500 - severe risk of infection

Symptoms of neutropenia

These symptoms belong to the infection caused when the immune system is weak as there is not enough number of blood cells to fight the germs. Some of these symptoms are-

• Fever > 100.5 degrees F
• Chills
• Sore throat
• Cough
• Shortness of breath
• Burning sensation and blood in the urine
• Lower back pain that could be a kidney infection
• Diarrhea
• Skin Rashes
• Redness and swelling at the IV site

Treatment to Manage Neutropenia

Most of these symptoms can be managed before they become too severe. There are certain medications for increasing the white cells count. These are essential because if the white cells count drops drastically, then the chemotherapy treatment for cancer would have to be cancelled or delayed. This would compromise on the effectiveness of the treatment. Hence, the doctor could recommend them these medications-

Preventative Antibiotics - These are recommended before the infections occur as a precautionary measure.

Medications - Medications like growth factors or colony stimulating factors are recommended to stimulate the production of neutrophils in the bone marrow. This could be recommended as a preventive medicine or after the cell count drops. Some of these medications are-

• Filgrastim, G-CSF
• Pegfilgrastim
• Sargramostim, GM-CSF

Myelosuppression is a condition that forces the dose of the chemotherapy drug to be reduced. This includes chemotherapy induced neutropenia and febrile neutropenia. The myeloid colony-stimulating factors are recommended to reduce the risk of febrile neutropenia and further complications.

These medications are available across the world and are commonly used for patients undergoing chemotherapy especially the ones with low white cell count.

If the infections that occur with neutropenia and chemotherapy are very severe or life threatening then the hospitalization would be required wherein antibiotics would be administered intravenously.

Chemotherapy induced neutropenia and the relevant complications are directly linked with significant morbidity, mortality and high costs. Hematological toxicity is most common in the initial cycles of chemotherapy and reduces gradually. However, this varies from patient to patient and depends upon the drugs and the dosage. Reduced chemotherapy dose due to this condition is observed more commonly among the elderly or obese cancer patients.