Leukocytes and Neutropenia



Next to cancer itself, defending an immune system compromised by chemotherapeutic agents is one of the most significant battles a cancer patient faces.

White Blood Cell Basics:

Leukocyte is the term that covers all six types of white blood cells:

  • Basophils circulate in the blood and signal the inflammatory response.
  • Eosinophils kill parasites and produce allergic reactions.
  • Lymphocytes produce antibodies and regulate immune responses.
  • Mast cells are fixed in tissues to signal the inflammatory response.
  • Monocytes capture, identify and ingest infecting organisms, and remove damaged or dying cells and cell debris. A monocyte that become fixed in tissue, is called a macrophage.
  • Neutrophils identify and kill infecting organisms, and remove dead tissue.
  • The life span of a leukocyte is approximately 1 to 3 days. White cells are more sensitive to chemo than red blood cells and platelets, possibly due to their rapid turnover.

    Chemotherapy destroys not only cancer cells but red cells, white blood cells and platelets. When the level of leukocytes drops the risk for infection increases. Chemotherapy may be delayed and/or a lower dosage may have to be given.

    One out of every three chemo patients will develop neutropenia.

    What is neutropenia?

    Neutropenia is measured by the Absolute Neutropenia Count or ANC, which is measured in cells per microliter of blood.

    Mild Neutropenia: between 2,000 and 1,000

    Moderate Neutropenia: between 1,000 and 500

    Severe Neutropenia: less than 500

    While each patient is evaluated on an individual basis, often chemo therapy will not be stopped until a patient reaches severe levels of neutropenia.

    The lowest point that a patient’s blood count drops after chemotherapy is called the nadir. The nadir usually occurs about seven to ten days after treatment. At this point a patient is the most susceptible to infection.

    Other Signs and Symptoms of Neutropenia:

    • fever
    • sore throat
    • mouth sores
    • signs of infection
    • diarrhea
    • burning with urination
    • shortness of breath

    Treatment:

    If you are neutropenic your health care team will do everything possible to protect your compromised immune system including prescribing antibiotics, and granulocyte colony stimulating factor.

    What is G-CSF?

    White blood cells are not given via transfusion since these cells only live for twenty-four to forty-eight hours. The risk of reaction is highly likely.

    Instead G-CSF is given. This injectable agent increases the production of neutrophils.

    Types of G-CSF:

    • Filgrastim (Neupogen): daily injections
    • Lenograstim (Granocyte) daily injections
    • Pegylated filgrastim (Neulasta) long lasting

    A summary of G-CSF by the National Cancer Institute:

    “Granulocyte colony-stimulating factor (G-CSF) is a hormone produced by the body that stimulates the bone marrow to produce more white blood cells. G-CSF is also made as a drug. Studies have found that G-CSF injections reduce the severity and duration of neutropenia in patients with some types of cancer. It’s been unclear, however, whether G-CSF is helpful only in certain circumstances or whether many patients with cancer might benefit from it. Treatment with a G-CSF drug is a form of biological therapy.”

    Personal Care:

    • Good hand washing
    • Keep the skin intact
    • Avoid others who have infections

    The American Cancer Society provides an excellent down loadable pdf document on cancer and neutropenia. Read it before you begin treatment.

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    NOTE: The contents in this blog are for informational purposes only, and should not be construed as medical advice, diagnosis, treatment or a substitute for professional care. Always seek the advice of your physician or other qualified health professional before making changes to any existing treatment or program. Some of the information presented in this blog may already be out of date.
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