Neutropenia in Childhood Cancer
Symptom Management, Palliative Care, or Supportive Care to relieve side-effects is an important part of cancer care and treatment and should always form part of the overall treatment plan.
Neutropenia is a low level of neutrophils (a type of white blood cell that compose around 60% of the white blood cells in the entire body) or neutrophil granulocytes. All white blood cells help the body fight infection. Neutrophils are made in the bone marrow and fight infection by destroying harmful fungi, yeast or bacteria that invade the body.
Some level of neutropenia occurs in around 50% of individuals with cancer who are undergoing chemotherapy treatment, and it is a common side effect in those with leukaemia. If your child has neutropenia, pay close attention to their personal hygiene, such as hand washing, to lower their risk of infection.
Individuals who have neutropenia carry a higher risk of developing serious infections because they do not have enough neutrophils to destroy organisms that cause infection. Individuals with severe or long-lasting neutropenia are more likely to develop an infection.
Relieving side effects is an important part of total cancer care and treatment, which is why you should discuss any symptoms your child is experiencing, new symptoms and changes in symptoms with their Oncology Team so that they can work out a regimen of palliative or supportive care for them.
Neutropenia itself may not cause any symptoms. Individuals usually find out they have neutropenia from a blood test or when an infection develops. Some people will feel more fatigued when they have neutropenia. Your child’s doctor may schedule regular blood tests to look for neutropenia and other blood-related side effects if they are undergoing chemotherapy treatments.
Even a minor infection can quickly become rather serious for individuals with neutropenia, so be on the lookout for the following symptoms in your child:
- Fever ( a temperature of 38°C or higher)
- Chills or sweating
- Sore throat, sores in the mouth, or a toothache
- Abdominal pain
- Pain near the anus
- Pain or burning when urinating, or urinating often
- Diarrhoea or sores around the anus
- A cough or shortness of breath
- Any redness, swelling, or pain, particularly around a cut, wound, or where a catheter was placed
- Unusual vaginal discharge or itching
Report any of the above symptoms in your child to their healthcare team immediately!
While Neutropenia is not always caused by cancer or cancer treatments, the following factors related to cancer and cancer treatment can cause a low level of neutrophils:
- Some types of chemotherapy
- Cancers that affect the bone marrow directly, such as leukaemia, lymphoma, and myeloma
- Cancer that has spread
- Radiation Therapy to several areas of the body or to bones in the pelvis, legs, chest, or abdomen
Some individuals with cancer are more likely to develop neutropenia, including those with a lowered immune system from other causes, such as HIV infection or organ transplantation.
Any drop in neutrophil depends on the type or dose of chemotherapy. Neutrophil counts generally start to drop about a week after each round of chemotherapy begins and reach a low point called the nadir about 7 – 14 days after treatment. Your child is most likely to develop an infection at this point. Neutrophil levels will begin to rise again as your child’s bone marrow resumes normal production of neutrophils; it may take 3-4 weeks to reach a normal level again.
When your child’s neutrophil level returns to normal, their body is ready for the next round of chemotherapy. Your child’s doctor may delay the next round of chemotherapy or lower the dose if your child develops neutropenia or your child’s neutrophil level does not return to normal quickly enough.
Your child’s doctor may recommend antibiotics during periods of prolonged neutropenia to try to prevent infections from occurring.
If chemotherapy causes neutropenia with a fever, your child’s doctor may prescribe medications called white blood cell growth factors, which help the body create more white blood cells.