Breast Cancer Patients: Managing Treatment for Low White Blood Cell Count

Quick summary

When a breast cancer patient's white blood cell count is low, her immune system isn't as strong as usual and she's at increased risk of infection, a condition known as neutropenia. The lower her white blood cell count is -- and the longer it stays low -- the higher the risk that she'll get sick or contract some type of infection. (Normal white blood cell counts range from 4,500 to 11,000 WBCs per cubic millimeter of blood. For more information, see Breast Cancer Treatment and Low White Blood Cell Counts .) 

What signs should I watch for that indicate the white blood cell count is in the danger zone?

  • Fever is often the first sign of infection, so keep an eye on body temperature. Call the doctor if body temperature climbs above 100 degrees.
  • Other common -- and sometimes overlooked -- areas of potential infection are the bladder and gastrointestinal system, so watch for stomach cramps, diarrhea, rectal bleeding, and urination problems.
  • Beware of cuts and scratches, and always apply antibiotic ointment and keep them covered, no matter how small and harmless they seem.
  • Make note of sore gums, mouth sores, or canker sores as these are common sites of infection. Remember, resistance isn't what it would normally be, making it hard for the body to fight off even normally harmless bacteria.
  • A cough, sore throat, sneezing, or headache can indicate a sinus or lung infection, so call the doctor if any of these symptoms develop. If you or the person you're caring for develops a fever or infection while suffering from neutropenia, you may need to go to the hospital for intravenous antibiotics to allow the body to build up enough white blood cells to fight off the infection.

How can we keep germs at bay when battling neutropenia?

  • The short answer: lots and lots of hand-washing, says Terry Anders, clinical educator at the Zangmeister Cancer Center in Ohio . Keep antibacterial soap in all bathrooms and next to the kitchen sink, and keep antibacterial wipes and hand purifying gel in the car, your purse, and anywhere else it might come in handy.
  • Use a disinfectant cleanser on all cooking and food preparation surfac es. When serving food, follow the basic rule of "cold food cold" and "hot food hot." Food that needs refrigeration should be left in the fridge until just before serving, and hot dishes, particularly those containing meat, should be heated through before serving.
  • Make sure to stay away from raw or undercooked meat and raw fish and shellfish, since those food can put a compromised immune system at further risk.

What other precautions should we take when white blood cell counts are low?

  • Dry, chapped skin can crack, letting infection in, so use plenty of hand lotion. Keep lotion near every sink as a reminder to use it after hand-washing.
  • Avoid gardening or other chores that could lead to cuts and scrapes -- or, at least, wear gloves.
  • Use an electric rather than manual razor, since there's less likelihood of cuts.
  • Use antibacterial mouthwash after brushing teeth.
  • Cook and reheat food thoroughly, so there's minimal chance of picking up a gastrointestinal bug.
  • Avoid having any dental work done -- not even a cleaning and checkup -- while white counts are low.

Is isolation necessary while white blood cell counts are low?

The doctor will likely warn you to avoid crowded places or gatherings where contact with people carrying germs is likely. In practical reality, though, it's probably better to let life go on as normally as possible. "There's no need to have a 'boy in the bubble' mentality, because that's very quic kly going to lower your quality of life," says Terry Anders, clinical educator at the Zangmeister Cancer Center in Ohio . "I try and put myself in the patient's shoes; I would hate for someone to act like a germophobe around me and say that I shouldn't visit friends or have the grandkids over. Plus, seeing the grandchildren is going to cheer you up, which has all sorts of benefits."

Do avoid anyone who's actively sick, though -- including children who've recently been vaccinated. And when you do come in contact with people, focus on hand-washing -- and more hand-washing -- and carry hand sanitizer with you everywhere you go. Disinfect doorknobs as well as food preparation surfaces.

What medications are available to boost white blood cell count?

Medications called growth factors can be used preventively before chemotherapy to boost white blood cell count , and they can also be used to increase production of white blood cells when levels drop too low. They contain cytokines, a type of protein, that stimulate the bone marrow to produce more white blood cells. The two most common drugs are filgrastim (brand name: Neupogen) and pegfilgrastim (brand name: Neulasta). Filgrastim is usually given as a series of daily injections during outpatient visits. Pegfilgrastim is given in a single dose.

Side effects from filgrastim and pegfilgrastim include fever, chills, fatigue, and aching in the bones, which most people feel in the hips, thighs, and upper arms. Itchiness and redness may occur at the site of the injection.

Less commonly given is sargramostim (brand name: Leukine). Clinical trials are underway to test the use of a particular type of stem cells, called peripheral blood stem cells, which stimulate neutrophil (white blood cell) production.

When will white blood cell counts rise again?

White blood cell counts usually start dropping three to seven days after a chemotherapy session and hit their lowest point, called the nadir, between seven and ten days after treatment. They can stay low for several days before beginning a slow climb back to normal or close to normal. However, some cancer medications can cause a more prolonged period of neutropenia. If white cell counts don't rise back to normal levels, the next round of chemo may have to be delayed, so it's important to boost white counts to keep chemo on track.