Neutropenia is an abnormal decrease in white blood cells most often resulting from a viral infection or exposure to certain drugs or chemicals. According to the Neutropenia Support Association, up to one third of patients who receive chemotherapy become neutropenic. The most common side effect of neutropenia is high fever. Patients whose body temperature rises above 101.5 degrees Fahrenheit while undergoing chemotherapy are encouraged to contact their physicians immediately to avoid potentially life-threatening effects of neutropenia.

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• How can breast cancer patients get neutropenia?
• How are patients with neutropenia treated?
• Additional types of neutropenia
• Additional resources and references

How Can Breast Cancer Patients Get Neutropenia?

For many breast cancer patients, chemotherapy is administered with or without breast surgery or other treatments to kill cancerous cells. Because chemotherapy is a systemic treatment, the drugs travel throughout the body to target cancer cells that may have spread past the breast. The human body is made up of red and white blood cells. Red blood cells carry oxygen to the lungs and different parts of the body while white blood cells protect the body from infection. Neutrophils, one common group of white blood cell produced in the bone marrow, divide and multiply quickly just like cancer cells. Since chemotherapy drugs aim for cancer cells with a high rate of reproduction, many of these neutrophils are also destroyed during treatment, resulting in neutropenia. Neutropenia is defined as a sharp reduction of neutrophils.

Patients with neutropenia tend to develop infections easily because their white blood cell count is too low to ward off threats to the body (such as foreign bacteria). Most infections occur in the lungs, mouth, throat, sinuses and skin. Some patients experience painful mouth ulcers, gum infections, ear infections, periodontal disease (disease of the tissues surrounding the teeth) or infections of the urinary tract, colon, rectum, or reproductive tract.

Symptoms of neutropenia may include:

• fever
• sore throat
• cough or shortness of breath
• diarrhea or loose bowels
• nasal congestion
• unusual vaginal discharge or itching
• burning during urination
• shaking chills
• redness, swelling or warmth at the site of an injury

Both men and women may develop neutropenia as a result of chemotherapy or another viral infection. Health care professionals are able to determine if a patient is neutropenic by analyzing the blood and calculating the absolute neutrophil count (ANC). The normal body contains between 2500 and 6000 cells per cubic millimeter. If a patient’s ANC is 1000 or less, he or she is considered to be neutropenic. A patient with ANC less than 500 cells per cubic millimeters is considered a severe neutropenic at great risk of developing infections.

How are Patients with Neutropenia Treated?

Most patients with neutropenia develop fever and are treated with antibiotics. Additionally, several new drugs called granulocyte colony stimulating factors may stimulate the growth of neutrophils. Two of these growth factors that stimulate production of white blood cells in the bone marrow are the granulocyte-macrophage colony stimulating factor (GM-CSF, generic name sargramostim, brand name Leukine) and granulocyte colony stimulating factor (G-CSF, generic name filgrastim, brand name Neupogen). Neutropenic patients may take these growth factors after they receive myelosuppressive chemotherapy (therapy to halt the production of blood cells in the bone marrow) for up to two weeks. Growth factors are usually administered by nurses when the patient is in the hospital, but patients (or their family members) may learn how to give themselves these injections at home.

According to Amgen, the manufacturer of Neupogen, patients with neutopenia should avoid:

• Contact with people who have colds or infections
• Situations where a bruise or break to the skin may result
• Immunization shots unless the patient’s physician approves
• Squeezing pimples
• Any new medications unless the patient’s physician approves
• Fingernail cuts or tears
• Cuts with sharp objects⁽¹⁾

Health care professionals will monitor a patient’s red and white blood cells counts during chemotherapy. If a patient’s white blood cell count becomes very low, a patient may have to stop chemotherapy and take growth factors to raise his/her cell count. Occasionally, physicians may prescribe growth factors as prophylatic (preventive) treatment to avoid low white blood cell counts.

A new drug called Neulasta (generic name, pegfilgrastim) is also now available from Amgen. It is a longer lasting form of G-CSF which patients only need to receive once per chemotherapy cycle, typically 24 hours after the cycle has been administered.

Additional Types of Neutropenia

Neutropenia is most common during or after a patient receives chemotherapy to treat cancer. However, according to the Neutropenia Support Association, there are several rare types of neutropenia that may affect both adults and children.

Types of neutropenia:

• Chronic congenital neutropenia: a rare inherited type of neutropenia that affect children more often than adults. Symptoms include frequent fevers, mouth sores, ear infections, pneumonia, or rectal sores. If untreated, many children may lose their teeth or develop severe gum infections. The most severe form of chronic congenital neutropenia is called Kostmann's Syndrome.
• Cyclic neutropenia: occurs in both children and adults and is often present in several members of the same family. Cyclic neutropenia tends to occur every three weeks and last three to six days at a time. Symptoms include fever, illness, and mouth ulcers. Children with cyclic neutropenia usually improve after puberty.
• Chronic idiopathic neutropenia: is a rare form of neutropenia that may result in life-threatening infections.⁽²⁾

Additional Resources and References

• (1) Amgen, the manufacturer of the drug Neupogen, provides detailed information on neutropenia at http://www.neupogen.com/
• (2) http://www.neutropenia.ca/ The Neutropenia Support Association Inc. is a registered charity formed in 1989 to increase awareness and understanding of neutropenia. The association provides assistance to neutropenic patients and their families and also raises money for research and education.
• For information on Leukine, please visit the website at http://www.leukine.com/
• For information on the drug Neulasta, manufactured by Amgen, please visit http://www.neulasta.com/
• For additional information on chemotherapy, please visit http://www.imaginis.com/breasthealth/chemo.asp
• The American Cancer Society provides information on neutropenia at http://www.cancer.org

Updated: November 16, 2007

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