From the Guidelines
If you have a low white blood cell (WBC) count and low neutrophils, it's essential to consult a healthcare provider for proper evaluation and management, as this condition can significantly increase the risk of infections, particularly bacterial and fungal infections, as noted in studies 1.
Implications of Leukopenia and Neutropenia
In general, a low WBC count (leukopenia) and low neutrophil count (neutropenia) can increase the risk of infections, with the frequency and severity of infection being inversely proportional to the neutrophil count 1. The primary sites of infection are the alimentary tract, sinuses, lungs, and skin, with common pathogens including coagulase-negative staphylococci, S. aureus, and coliforms 1.
Precautionary Measures
As a precautionary measure, it's recommended to:
- Avoid contact with people who have infections
- Practice good hygiene, such as frequent handwashing
- Avoid raw or undercooked foods that may contain bacteria
Medication and Treatment
In some cases, medication may be prescribed to stimulate the production of WBCs and neutrophils, such as:
- Filgrastim (Neupogen) 300 mcg subcutaneously daily for 5-10 days
- Pegfilgrastim (Neulasta) 6 mg subcutaneously once
It's crucial to follow the healthcare provider's guidance and attend scheduled follow-up appointments to monitor your condition and adjust treatment as needed, as the risk of infection is highly dependent on individual patient factors, including the underlying malignancy, degree of neutropenia, and past history of infections 1.
Monitoring for Infections
Additionally, if you experience any symptoms such as fever, chills, or signs of infection, seek medical attention immediately, as fever can be an important indicator of infection, particularly in severely or profoundly neutropenic patients 1.
From the FDA Drug Label
Reduce the incidence and duration of sequelae of severe neutropenia (e.g. ‚ fever‚ infections‚ oropharyngeal ulcers) in symptomatic patients with congenital neutropenia‚ cyclic neutropenia‚ or idiopathic neutropenia (1.5)
Most common adverse reactions in patients: • With nonmyeloid malignancies receiving myelosuppressive anti-cancer drugs (≥ 5% difference in incidence compared to placebo) are pyrexia, pain, rash, cough, and dyspnea. (6.1) • With severe chronic neutropenia (SCN) (≥ 5% difference in incidence) are pain, anemia, epistaxis, diarrhea, hypoesthesia and alopecia. (6. 1)
The implications of leukopenia and neutropenia include:
- Increased risk of infection: as manifested by febrile neutropenia
- Fever
- Oropharyngeal ulcers
- Pain
- Anemia
- Epistaxis
- Diarrhea
- Hypoesthesia
- Alopecia 2, 2, 2
From the Research
Implications of Leukopenia and Neutropenia
- Leukopenia and neutropenia can have significant implications for an individual's health, particularly in terms of increased susceptibility to infection 3, 4, 5.
- Benign ethnic neutropenia, a condition characterized by low leukocyte and neutrophil counts, is common in persons of African descent and some ethnic groups in the Middle East, and is not typically associated with increased susceptibility to infection 3.
- Neutropenia can be a marker of bacterial infection, and changes in white blood cell count and neutrophil left shift can reflect the severity of the infection 4.
- In neonates, low white blood cell counts, low absolute neutrophil counts, and high immature-to-total neutrophil ratios are associated with increasing odds of infection, but are not sensitive enough to rule out early-onset sepsis 5.
- A regulatory variant in the Duffy antigen receptor for chemokines gene has been identified as a cause of reduced neutrophil count in people of African descent 6.
- Neutrophil count, lymphocyte count, and neutrophil-to-lymphocyte ratio may be useful biomarkers to guide selection of community-acquired pneumonia patients who are more likely to benefit from adjunctive dexamethasone treatment 7.
Association with Infection
- Leukopenia and neutropenia can increase the risk of infection, particularly bacterial infections 4, 5.
- Neutropenia can be a marker of bacterial infection, and changes in white blood cell count and neutrophil left shift can reflect the severity of the infection 4.
- In neonates, low white blood cell counts, low absolute neutrophil counts, and high immature-to-total neutrophil ratios are associated with increasing odds of infection 5.
Biomarkers for Treatment
- Neutrophil count, lymphocyte count, and neutrophil-to-lymphocyte ratio may be useful biomarkers to guide selection of community-acquired pneumonia patients who are more likely to benefit from adjunctive dexamethasone treatment 7.
- White blood cell count and/or neutrophil count may be easily available biomarkers to guide selection of patients who are more likely to benefit from adjunctive dexamethasone treatment 7.