What is Neutropenia?

Neutropenia is a condition where there is a significant decrease in the number of neutrophils in the blood. Neutrophils are a type of white blood cells (WBC). WBCs are responsible for the immune response or the fighting of infection in our body. There are many kinds of WBCs, each having a particular function. Neutrophils function by leaving the blood to destroy invading bacteria and fungi in the cells. Therefore, insufficient neutrophils in the body result in infections.

Neutrophil levels in the blood may become low either due to insufficient production in the marrow, excessive destruction of cells in the blood, or increased removal from the blood by the spleen.


Why is it important to treat Neutropenia?

Chemotherapy-induced neutropenia is critical because it may increase a patient’s risk of life-threatening infection and/or disrupt the delivery of cancer treatment. When there is a significant drop of neutrophils in the blood for longer periods, patients become more susceptible to developing bacterial or fungal infections.  Neutrophils are a major component of antibacterial defense mechanisms. As the neutrophil count falls below 1.0, 0.5, and 0.1 x 10⁹/L, the frequency of life-threatening infection rises steeply from 10% to 19% and 28%, respectively. If patients develop fever during neutropenia (called febrile neutropenia), they may require treatment with intravenous antibiotics and admission to the hospital until the number of neutrophils in the blood returns to adequate levels to fight the infection.

In cases of severe neutropenia, chemotherapy may be delayed or doses reduced, which in turn may reduce a patient’s chance of being cured. Patients are given chemotherapy in order to destroy cancer cells, reduce symptoms of cancer, prolong survival and increase chances of a cure. The dose and time schedule of chemotherapy drugs administered have all been scientifically determined to produce the best chances of survival or cure. If patients develop neutropenia, doctors may have to delay the treatment or reduce the doses of chemotherapy until the neutrophil counts have normalized.

Who are at a higher risk of acquiring Neutropenia?

• Patients receiving chemotherapy that decreases the number of white blood cells
• Patients who already have a low white blood cell count
• Those who have previously received chemotherapy or radiation treatment
• Patients aged 70 and older, who may be at risk of more severe infection and longer hospitalizations
• Patients with other conditions affecting their immune system

What are the causes of Neutropenia?

Lowered production of white blood cells is the most common cause of neutropenia. Neutropenia, besides chemotherapy or radiotherapy, can also result from severe bacterial infections, protozoal infections such as malaria or typhoid fever, or viral infections (such as HIV, hepatitis, measles). It can also be caused by disease of the spleen, bone marrow tumors or diseases such as leukemia, agranulocytosis, aplastic anemia, rheumatoid arthritis, and systematic lupus erythematosus(SLE). Drugs and chemicals that may cause neutropenia include penicillin and those used in cancer chemotherapy. The ionizing radiation used in cancer therapy and folic acid deficiency or vitamin B12 deficiency may also cause neutropenia. In addition, neutropenia may be related to alcoholism.

What are the symptoms of Neutropenia?

Neutropenia may be associated with fever, easy bruisability, petechiae (small red-purple spots on the skin), enlarged glands in the throat, and an enlarged spleen if accompanied by anemia and thrombocytopenia (abnormally low number of platelets in the blood), causing weakness, pallor (paleness of complexion) and bleeding.  In addition, the patient shows signs of infection.

How is Neutropenia diagnosed?

Neutropenia is diagnosed by patient history, physical examination for symptoms, and laboratory testing (Complete Blood Count). The diagnosis usually involves blood testing and may also require bone marrow sampling to determine the cause of the problem.

How is Neutropenia treated?

Treatment of neutropenia depends on the underlying cause
 Patients with fever and other signs of infection are treated with antibiotics. Some antibiotics used in the treatment of cancer patients include imipenem, meropenem, aminoglycoside, antipesudomonal penicillin, rifampicin, and vancomycin. Combination therapy can also be used with several types of antibiotics to stop the infection, but some of the drugs may be toxic or costly.

Patients receiving chemotherapy for cancer may be given drugs even in health to help restore the WBC to normal. A commonly used medication to reduce neutropenia in cancer patients is the cytokine G-CSF (granulocyte colony-stimulating factor, or filgrastim). This substance is normally produced in the body at low levels. G-CSF helps the body produce more neutrophils to recover the counts to normal and to fight infection.