Cancer patients who are undergoing (or have undergone) chemotherapy tend to experience neutropenia. This is typically a side effect of the treatment, resulting in a significantly reduced white blood cell count.
Neutropenia is a condition where there are appreciably downsized levels of neutrophils being circulated in the blood. Alright, I heard your question: what are neutrophils?
To combat infections and invading pathogens, your body needs a fortified "battalion" of white blood cells. Now, neutrophils are the precise kind of white blood cells needed to ward off diseases.
The sad reality is that when a cancer patient undergoes chemotherapy – a crucial treatment regimen – neutropenia is induced. In the chemotherapeutic process, drugs are administered to the patient to kill off the cancerous cells.
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These drugs work by targeting cells that are growing at an incredibly fast rate. Such growth speed is characteristic of cancer cells. But here is the sad part of the story. Some beautiful cells grow fast too. Cells domiciled in your hair follicles, intestines, or even blood cells in your bone marrow develop rapidly.
Regrettably, chemotherapy is less discerning as it destroys all the fast-growing cells, both the good guys and the cancer cells. It is like throwing away the baby with the bathwater, right?
When neutropenia comes into the scene, your immunity is substantially suppressed, and you find yourself at a larger risk of infections – like the fungal and bacterial variant.
Neutropenia – as induced by chemotherapy – can occur seven days after your chemotherapy. In some unique incidences, such neutropenia can occur as early as three days after chemo.
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Depending on your chemotherapeutic dosage and treatment type, your neutropenia may be ephemeral or more long lasting. Within this interval, neutrophil levels would be remarkably low.
Well, it is important to point out that neutropenia isn't an exclusive consequence of chemotherapy. There are isolated cases where underlying cancer can cause neutropenia. In other patients, other medications can induce neutropenia.
The bulk of responsibility lies on the table of your healthcare provider. Your physician must accurately decipher which type of neutropenia you are experiencing (if yours is induced by chemotherapy) to know the appropriate way to manage it.
How can you identify neutropenia?
It is imperative to regularly confirm your neutrophils levels are appropriate as you undergo chemotherapy. This is ascertained by checking for your complete blood count (CBC).
The blood –as amazing as it is – boasts billions of neutrophils. The CBC test would give the physician an accurate picture of the patient's ANC (Absolute Neutrophil Count). When it is a case of low white blood count, it means the patient's neutrophil counts are unusually low.
When the patient's ANC reading comes out under 1,500 cells/mm3, it is mild neutropenia. When the ANC reads below 1,000 cells/mm3, it is a case of moderate neutropenia.
The alarm bells go violently ringing when the ANC reads below 500 cells/mm3. This is a case of severe neutropenia, with the patient being particularly vulnerable to infections.
Are some people more vulnerable to chemotherapy-induced neutropenia?
Yes, some categories of individuals are uniquely more vulnerable to neutropenia. First, a patient older than 70 years who may have been extensively hospitalized or more vulnerable to severe infection will more likely experience neutropenia.
As we have pointed out, patients receiving chemotherapy are at higher risk of experiencing neutropenia. More than this, patients with prevailing reduced low white blood cell count (from previous radiation treatment or past chemotherapy) have an increased risk of neutropenia.
Additionally, if a patient has an underlying condition that suppresses their immunity, such a patient is at a higher risk of experiencing neutropenia.
How about the risk of infection for senior patients undergoing chemo?
Seniors are infamously vulnerable to a broad spectrum of conditions – with neutropenia counting among them. A large percentage of seniors undergoing chemotherapy register a notable slump in their neutrophil count.
Compared to younger folks, elderly patients are inherently more susceptible to complications related to a drop in the white cell count that combats infection. Upon hospitalization, seniors tend to stay longer on their sickbeds compared to younger patients.
Let us shed a more realistic light on this, shall we?
Meet Mrs. Bett, a lovely senior, aged 68 years, and Mark, an enterprising 28-year guy. Both individuals have non-Hodgkin's lymphoma and are undergoing chemotherapy. Mrs. Bett – consequent of her advanced age – is significantly more vulnerable to suffering complications from other infections than the much younger Mark.
Now, depending on how consequential this is, the physician may be forced to abandon the chemotherapy if the elderly patient is swamped with infections.
Such chemotherapy would only be resumed when neutrophil levels start climbing up. Sadly, this cessation in chemotherapy (or a reduction in dosage) can trigger the increased progression of the cancer cells.
Why should you bother about neutropenia caused by chemotherapy?
We don't mean to get you frantic, but you should be genuinely bothered about chemotherapy-induced neutropenia. When you experience neutropenia, erstwhile trivial infections that your immunity readily sends packing will become suddenly become more challenging to overcome.
For example, when a patient experiencing neutropenia suffers fever (an infection that your immunity will independently eradicate in the good old days), he may need intense hospitalization or being treated with intravenous antibiotics. This is to activate the required resurge in white blood cell count to fight off the disease.
Neutropenia amplifies your risk of suffering a fatal infection. Being that neutrophils are major stakeholders in your defense against bacteria, a dwindling neutrophil count makes you extremely vulnerable to fungal and bacterial infection.
Typically, when a patient's neutrophil density drops from 0.5 to 0.1 x 109/L, the patient's risk of death from an infection correspondingly leaps from 19% to 28%. Alarming?
The disruption neutropenia introduces into a cancer patient's original treatment plan is worth worrying about. When neutropenia sets in, the physician would be forced to slash the dosage of the chemotherapy, or in some extremely severe cases, entirely stop the treatment.
This abrupt cessation or reduction in the chemo medication aims to give the patient's system enough time to pump up their infection-combating white blood cell.
Sadly, such a pause triggers a faster development of the cancer cells, effectively downsizing the patient's chances of surviving the cancer.
Studies have revealed that when your provider reduces your chemo doses for some specific types of cancer, the cure rate is reduced as well. Similarly, when the windows between treatment procedures (in your plan) lengthen, the cure rate diminishes too.
It is almost appearing like choosing between the devil and the deep blue sea (cancer or neutropenia), isn't it? The good news is clinicians have come up with effective ways to reduce the occurrence of chemotherapy-induced neutropenia.
With the religious application of these strategies, the patient's risk of suffering an infection, fever, delays in treatment, or even ultimately getting hospitalized, is appreciably reduced.
Eager to learn about these strategies? We will tell you.
What can be done to prevent neutropenia?
Emerging treatments with white blood cell growth factors have proven immensely helpful in preventing neutropenia as triggered by chemotherapy. These blood cell growth factors are generally termed cytokines, and they occur naturally.
Cytokines play a fundamental role in regulating crucial metabolic processes in our bodies. These are the substances saddled with amplifying blood cell production via the stimulation of bone marrow cells.
Medications like Neulasta and Neupogen have been approved by the U.S. Food and Drug Administration for preventing this said neutropenia.
How about treating older people?
For elderly cancer patients, they desperately need their treatment plan to go on smoothly without any disruption. Outcomes are dramatically different (in a positive sense) for seniors if they receive full chemotherapy doses and on time. This is primarily in the case of treating tumors.
This makes neutropenia highly undesirable for elderly patients. Of course, considering the relatively heightened vulnerability of seniors (compared to younger patients) to neutropenia, preventing neutropenia in older patients can be the difference between survival and death.
Excitingly, there are now medications that boost the neutrophil count in seniors. These boosters can stimulate the increased production of white blood cells.
This ensures there is a reasonable amount to fight off infections triggered by chemotherapy. With this fortification in place, disruptions in chemotherapy treatment can be largely avoided for seniors.
Isn't this worth throwing a party?
