Infection

Cancer and the effects of treatments can increase your risk of infection.

What is neutropenia?

Neutropenia is when neutrophils, a type of white blood cell that helps fight infection, are low. The lower your neutrophil count drops the greater your risk of developing an infection and the harder it is for your body to deal with the infection on its own.

What causes neutropenia?

Chemotherapy affects the rapidly dividing cells in bone marrow where new blood cells are formed. Diseases such as leukaemia, myeloma and lymphoma directly affect the bone marrow and interfere how your body forms infection fighting cells.

What are the symptoms of infection?

You may have blood tests at different times throughout your treatment to check on your neutrophil count. The signs and symptoms of an infection may include:

  • a temperature of 38°C or above
  • chills or shakes, unusual sweating
  • cough with yellow or green coloured sputum, shortness of breath
  • sore throat, sores in your mouth
  • redness or swelling on your skin (particularly around a central line)
  • loose or liquid bowel motions
  • passing more urine than normal or a burning feeling when passing urine
  • blood or discharge in your urine
  • discharge from your eyes or ears
  • vaginal discharge and/or itching
  • flu-like symptoms such as body aches and feeling tired

How can neutropenia and infection be prevented/managed?

Neutropenia can be reduced or avoided with administration of growth factors such as granulocyte colony stimulating factor (G-CSF). This treatment is only used with certain types of chemotherapy. Your doctor will decide if this medication is suitable for you.

If your neutrophil count is low or has not returned to normal, your doctor may delay your next treatment or reduce your dose of chemotherapy. Your doctor will make these decisions based on your individual circumstances.

Neutrophils are commonly at their lowest point seven to 14 days after starting treatment. During this time, it’s important to reduce your risk of infection. You can do this by:

  • washing your hands on all sides including your fingertips before eating and after using the bathroom, sneezing etc. You should use a waterless cleaner if you do not have access to soap and water
  • showering every day
  • cleaning cuts, scrapes, sores and/or stings immediately with warm water, soap, and antiseptic. Do not squeeze or scratch pimples
  • preventing constipation. If you need a laxative, ask your doctor or pharmacist. Avoid rectal suppositories or enemas
  • avoiding sexual intercourse if severely neutropenic
  • speaking to your doctor before you have any dental treatment and let your dentist know that you are receiving cancer treatment. Brush your teeth with a soft toothbrush after eating and before bedtime
  • checking with your doctor before you receive any immunisations. If you are exposed to people who have chickenpox, shingles or measles, tell your doctor
  • staying away from large crowds of people until your neutrophil count has improved
  • staying away from construction and building sites where there is a lot of dust
  • wearing protective gloves and shoes when working outside (do not handle potting mix)
  • avoiding handling pet waste or cleaning fish tanks
  • practicing good food hygiene and making safe dietary choices
    • wash your hands before eating and after handling food
    • clean and cook foods thoroughly
    • thoroughly wash and peel fresh fruit and vegetables
    • wash knives and cutting boards after handling uncooked foods
    • avoid take away meals, especially chicken, food kept under hot light and ready-made salads
    • avoid shell fish, prawns, oysters, smoked fish, sushi, pate and deli meats
    • avoid soft cheeses such as feta, brie, camembert and blue vein
    • if food needs to be reheated, it should be heated until it is hot throughout and then allowed to cool to the right temperature

When should I seek help from a health professional?

If you develop an infection when your neutrophil count is low, it can be life-threatening and needs to be taken very seriously. Even if you feel well you should go to your nearest hospital emergency department immediately via an ambulance if you:

  • develop a temperature of 38°C or higher
  • develop shivers, shakes or begin to feel unwell

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