Infection risk and neutropenia

When you have low levels of neutrophils in your blood, your immune system is weakened, making it harder for your body to fight infection. This is called neutropenia or being neutropenic. If you get an infection while you’re neutropenic, you’ll need treatment and may need to go to hospital.

You’ll also be at risk of a serious condition called neutropenic sepsis, which can be life-threatening.

If you have blood cancer and you get any symptoms of infection, you should contact your medical team immediately, no matter how minor or vague the symptoms seem. We have more information on the symptoms of infection.

Neutropenia can be caused by blood cancer. It can also happen during or after cancer treatments, such as chemotherapy, a stem cell transplant, or medications which suppress your immune system.

If you’re neutropenic, your doctor, dietitian or key worker may suggest that you make some changes to your lifestyle to lower your risk of getting an infection. Sometimes this includes changes to your diet.

There are some signs and symptoms you might notice if you’re neutropenic – but everyone is different so not everyone will have the same symptoms.

Neutropenia symptoms include:

• feeling sick (nausea)
• extreme tiredness (fatigue)
• infections that go on for a long time or keep coming back
• a painful and mouth ulcers (mucositis)
• loss of appetite.

If your other blood counts are low this may also affect how you feel. For example, if you’re anaemic (have a low number of red blood cells) you may feel weak, tired and breathless.

For more information and tips about avoiding infection, you can order a free copy of our infection fact sheet.

A full blood count (FBC) will tell you if you have neutropenia.

An FBC is a blood test which measures the number of each type of cell in your blood: red cells, white cells and platelets. A small sample of blood will be taken and checked under a microscope in a laboratory. This is known as a blood film.

The test will also show the neutrophil levels in your blood – you might hear this called a neutrophil count or an absolute neutrophil count. A neutrophil count measures how many neutrophils you have per cubic millimetre of your blood.

There’s no agreed definition of neutropenia, and normal blood ranges will vary between hospitals, but the most common neutropenic ranges are:

• Between 2.0 and 7.5 x 10^9/litre: not neutropenic
• Less than 2.0 x 10^9/litre: neutropenic
• Less than 0.5 x 10^9/litre: severely neutropenic

If you’re neutropenic or severely neutropenic, you’ll need to take extra care to avoid infections that you might pick up from food, other people or the environment around you. We have guidance on general hygiene and food safety for people who are at higher risk of infection, including from neutropenia.

It’s important that your friends and family understand how neutropenia affects you. You may need to explain neutropenia to them so they know how to best support you.

These conversations may be difficult or awkward. You could ask your healthcare team to explain neutropenia to them. You could also share this health information with them or order our booklet about eating well with blood cancer.

You should always discuss what changes are right for you with your doctor or nurse.