Managing Treatment for Low White Blood Cell Count
When someone's white blood cell count is low, his immune system isn't as strong as usual and he's at increased risk of infection, a condition known as neutropenia. The lower his white blood cell count is -- and the longer it stays low -- the higher the risk that he'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 understanding low white blood cell counts.
What signs should I watch for that indicate someone's white blood cell count is in the danger zone?
- Fever is often the first sign of infection, so keep an eye on his temperature. Call his doctor if his 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, since these are common sites of infection. Remember, his resistance isn't what it would normally be, so his body can't 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 he develops a fever or infection while suffering from neutropenia, he may need to go into the hospital for intravenous antibiotics until his body builds up enough white blood cells to fight off the infection.
Precautions to Take When White Blood Cell Count is Low
How can we keep germs at bay when someone has 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 surfaces. 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.
- It probably goes without saying, but make sure he stays away from raw or undercooked meat and raw fish and shellfish when his immune system is compromised.
What other precautions should we take when someone's white blood cell count is low?
- Dry, chapped skin can crack, letting infection in, so it's a good idea to use plenty of hand lotion. Keep lotion near every sink so he's reminded to use it after hand-washing.
- If he insists on gardening or doing other chores that could lead to cuts and scrapes, suggest that he wear gloves.
- Shaving with an electric rather than manual razor is a good idea, since there's less likelihood of cuts.
- Encourage him to use antibacterial mouthwash after brushing his teeth.
- Cook and reheat food thoroughly so there's minimal chance of picking up a gastrointestinal bug.
- It's also best to avoid having any dental work done -- not even a cleaning and checkup -- while his white count is low.
Do I need to keep someone isolated while his white blood cell count is low?
The doctor will likely warn you to avoid crowded places or gatherings where he might come in contact with people carrying germs. In practical reality, though, it's probably better to reign in your paranoia and let life go on as normally as possible. "There's no need to have a 'boy in the bubble' mentality, because that's very quickly going to lower his quality of life," says Anders. "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 him up, which has all sorts of benefits."
Certainly avoid anyone who's actively sick -- including children who've recently been vaccinated -- but otherwise, don't worry about it too much. Instead, Anders says, 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.
Boosting White Blood Cell Counts
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 the patient may 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 can I expect white blood cell counts rise again?
White blood cell counts usually drop 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 up to normal or close to normal. However, some kinds of cancer and some cancer medications can cause a more prolonged period of neutropenia. If the white count doesn't rise back to normal levels, the next round of chemo may have to be delayed, so it's important to boost white counts with growth factors to keep chemo on track.