Managing Treatment for Low White Blood Cell Count

All Rights Reserved

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.

Melanie Haiken

Melanie Haiken discovered how important it is to provide accurate, targeted, usable health information to people facing difficult decisions when she was health editor of Parenting magazine. See full bio

about 1 year, said...

Are there any foods or supplements that can raise the low white blood count.

over 1 year, said...

My white blood cell count is very low. I don't know why... i had a bone marrow test done and I continue to have blood work. My marrow test came back negative however, my count continues to be low. My next test will be a Pet scan. Why I have noticed is i have fatigue like I have never have before and some days are harder then others. What can I take to help with fatigue??? The Dr thinks I have a bacterial or viral infection. Any advice would be great.

over 1 year, said...

What causes the low blood count when you don't have cancer you don't have any chemotherapy or anything in otherwise feel healthy

almost 2 years, said...

Hi I had a blood test few weeks ago and it happens that my white blood cells in low and I would like to know what I do about it Ido wash my hands very often I exercise every day I swimming two days a week lots of walking eats lots of vegetables more than anything else keeping my environment clean not a drinker not a smoker I have taken lots of good test no one told me my blood cells was yet to be low I need to know what to do to get it back up a bit

almost 2 years, said...

Hi, my niece has completed her chemotherapy treatment for ovarian cancer about 6 months ago and has just been told she has to go back on the chemotherapy drugs because of a bad blood test result. Please tell me what this means. Thankyou

about 3 years, said...

Hello, My wife came out with low white blood cell count for the second time in two weeks... First time ever. Her doctor had asked for lab testing to be done on my wife just to ensure there was nothing to worry about after breaking a rib when she fell in the bathroom. Is there any chance that something may have to back to "normal" after her fall and when she should be repeating the lab testing?

over 3 years, said...

Ms. Haiken, The correct medical terminology associated with low white blood cell count is "leukopenia", not neutropenia. Wondering what your medical qualifications are, to be posting items such as this ..... ???

almost 4 years, said...

Why is it that all articles do everything except tell us what to Eat to build low count of White and Red Blood cells?

over 4 years, said...

What about if you are in the hospital and on iV antibiotics already. Then your white blood count goes from in the 10's to in the 4's?

almost 5 years, said...

My husband has a white blood count of 2.5 & that is really low, what will Dr do about this? Have to go back tomorrow for more blood work..what is normal white blood count? Thanks

almost 5 years, said...

My mom is getting chemotheraphy. She had her treatment on Thursday now today Saturday she feels a little light headed. Is this a sign of the white blood count dropping????

about 5 years, said...

learing about side effects from the drugs and really the entire article

about 5 years, said...

i have lung cancer spread to below on chemo to keep this from spreading. BUT TO EVERYONE WITH CANCER please check out radiation and radiosurgery.the combo r and rs killed my lung camcer and with no pain. in fact u can still work. just need chemo to stop from spreading.i got shot after 3 round to keep white cell count high. unfortunately it put me in the hospital with bone pain in head.for 10 days my head pain was a 10 unbearable.this time i will pass on shot and have them give me antibiotics.just have to have blood drawn more often.just had blood transfusion red cell count low and i feel like a different person.

about 5 years, said...

His? This is so old fashioned. Why not Her?

about 5 years, said...

i am having white blood cell of 6. something ... are these okay ? :0

about 5 years, said...

My friend is receiving chemotherapy for lung cancer. The cancer is called adenocarcinoma as it started in the esophagus which was removed she has been considered a miracle as she is in her sixth yearoif recovery--now the cancer has come back in her lungs she went for her 5th chemo treatment and her white count was a1 She said the dr says she must have a shot for two days. She is not the type to ask any questions Do you know what the shot is?

over 5 years, said...

My white Blood cells were low..and steady dropping. My family doctor and oncologist did not know why it was so low, they only continued to monitor it as the numbers continued to drop. There are a few things that help my numbers improve. 1. Added more vitamin D to my diet. 2. I started taking Beta glucans. Just one every other day. 3. I started exercising more walking, tai chi. 4. Believe it or not I read much about the benefits of taking cold showers. This is suppose to boost your immune system. I Well at my last doctor visit for the first time my white blood cells did come up a little. I will continue to monitor it and see how things go. Regards, Marvel

almost 6 years, said...

Thank You All for such GREAT Help!! I appreciate this, if you can help me further, It would be Great!!!! Thank You again

almost 6 years, said...

This website has a list of many foods and supplements which promote white blood cells.

almost 6 years, said...

I want to ask a question. My husband has low white blood count, hes been seen by medical, oncology, gastologist, had many test, 6 catscans in the past year oncologist says no to cancer, gastro cant find anyything wrong what do we do his medical doc. keeps wanting catscans run.

almost 6 years, said...

For the past year I have been taking white blood cell injections subqutaneously to increase my white blood cell count which was critically low. I started out every week and now can go every 3 weeks. It is semi-experimental and took almost 6 months for me to feel better. Not for everyone as I do injections myself and it is very expensive (insurance covers most of it for me) but the results are amazing. My doctor figured out from my history that I was cronically ill and did not recover from recuring colds-broncitis-pneumonia rapidly. Hooray for a doctor that was actually paying attention.

almost 6 years, said...

Thank you for this informative article, The data on white count levels has helped me understand my readings. I am, however, not undergoing any kemo but still suffer from low white count levels. Am still looking for more answers as to why this is happening!!!! I do suffer from numerous allergies and feel this is a factor in my health. Thanks again in the great article.