Article last reviewed on 5-25-10
Breast cancer patients generally have been well counseled about the possible side effects of chemotherapy and radiation. In some cases, however, women may be dealing with low blood counts and not thoroughly understand how this can affect not only how they are feeling, but their overall health as well.
In fact, it is possible for low blood counts to actually be life threatening. Low white blood cell counts (WBC) can be particularly problematic, because your white blood cell count is so closely tied to your immune system’s ability to protect you from infection.
Understand the Lingo
Because a low white blood count can be life threatening, it’s a good idea to familiarize yourself with the symptoms and terminology. When you get your blood work, the lab will be looking for:
- Leukopenia – A decrease in the total number of white blood cells, which can lead to a lowered white blood cell count.
- Neutropenia – A decrease in the number of neutrophils, also creating a lower WBC.
- Granulocytopenia – Another term that may be used for Neutropenia.
Since your white blood cells fight infection, whenever you have a complete blood count (CBC) done they will be taking a close look at your WBC in the process. Although normal values for these blood counts will vary somewhat from laboratory to laboratory, the following provides a general overview of what is deemed “normal” for an adult:
- White Blood Cell Total 4 – 11 k/ul
- Lymphocytes 22 - 44%
- Monocytes 0 – 7%
- Neutrophils 40 – 70%
- Eosinophils 0 – 4%
- Basophils 0 – 1%
Your risk of infection depends upon several factors:
- How low your white blood count falls;
- How long your white blood count is low;
- Which type of low white blood cell count you have;
- Other medications you may be taking (such as steroids or immunosuppressive agents).
Your doctor may talk to you about your absolute neutrophil count (ANC). The ANC is calculated by multiplying your total white blood count by the percent of neutrophils (total WBC x % neutrophils = ANC).
Neutrophils are often reported as segs and bands (a band is a slightly less mature form of a seg). When this is the method used, they add the % of segs to the % of bands and then multiply the total number of white blood cells (% segs + % bands x total WBC = ANC).
This information allows your doctor to determine whether you are at an increased risk of infection, and if so, how great that risk may be. If you have an ANC of:
Greater than 1500
There is no increased risk of infection
There is a slight increase in the risk of infection
There is a moderate increase in the risk
High risk of infection
Less than 100
Extremely high risk of infection
Take Precautions... Watch for Symptoms
The importance of keeping your WBC as high as possible is quite significant when your body is already getting the double whammy of surgeries, chemotherapy and other cancer treatments. There are things you can do to reduce your risk of infection if your count happens to be lowered:
- Make sure you wash your hands frequently and ask family and friends to do likewise.
- Whenever possible, try to avoid coming into contact with anyone who is sick. If you happen to discover that you’ve been exposed to a cold or other infection, it’s a good idea to contact your health care professional.
- You should not have any dental work done if your WBC is low.
One of the things that sometimes make it difficult to tell that your WBC has been compromised is that you may not have the usual signs or symptoms associated with an infection. We all know we should be aware of redness, swelling, pus at the site of an injury or incision, a cough, unusual sputum or mucus, or nasal drainage. But it is vitally important for you to let your doctor know if you begin to feel ill or under the weather, even if none of those symptoms is present.
You need to contact your doctor immediately if you experience:
- A temperature greater than or equal to 100.5 degrees F (your doctor may want you to call if your temperature is greater to or equal to 100 F);
- Chills or shakes;
- Sudden onset of a new, unexplained pain or discomfort.
You should also contact your doctor within 24 hours if you experience:
- A sore throat;
- Sores in your mouth;
- A white coating in your mouth, especially on your tongue (this can be an indication that you’ve developed thrush (a type of yeast infection);
- Any signs associated with a bladder infection such as burning when you urinate, blood in your urine, a need to urinate more frequently, or the need to urinate in such a hurry you have difficulty making it to the bathroom in time.
If it is determined that you are suffering from a low WBC, your doctor is likely to prescribe possible treatments. These include Filgrastim (Neupogen), Peg - Filgrastim (Neulasta), and Sargramostim (Leukine). These medications are often given after each cycle of chemoterapy in order to prevent your WBC from dropping too much.
If your doctor is trying to prevent specific infections that are common when the immune system has been suppressed by chemotherapy or other medications, he or she may prescribe any number of antibiotics, depending upon whether you are allergic to something, and the type of infection they are hoping to fight. Just a few of these include Sulfamethoxazole - trimothoprim, Acycolovir, Flucanozole, and Intraconazole.
Healthy Habits... Be Proactive Every Day
We’ve talked briefly about basic precautions to observe when faced with low white blood cell counts. There are also ways to be proactive so that you are protecting yourself in your day-to-day activities. Paying attention to good hygiene, making sure you are eating a well-balanced and nutritious diet, avoiding unnecessary stress, getting moderate exercise when you feel well enough, and getting sufficient sleep are even more important while undergoing treatment than ever. Any activity or practice that helps your body’s immune system can help to prevent infections.
Even your food selection and preparation plays an important role when your immune system is compromised. Make sure you:
- Don’t eat raw or undercooked foods like eggs, poultry, meat, seafood or any unpasteurized dairy products. (Remember that some hollandaise sauces, Caesar dressings and mayonnaise may contain raw eggs – so they should be avoided.)
- Wash all produce thoroughly before you eat it.
- Be particularly careful about cross-contaminating your food. Don't let uncooked meats come into contact with other foods you are going to eat. Your hands, cutting boards, counters, knives and other utensils should be washed thoroughly after contact with uncooked foods. If someone else is preparing your meals, make sure they follow these precautions as well.
- Don’t share food, drinking glasses or eating utensils with anyone else.
If you are having treatment during the influenza season, it’s recommended that you have a flu shot. The pneumoccocal vaccine (a vaccine to prevent pneumonia) is also recommended for all patients. If you have not had chickenpox, you should discuss whether or not getting the Varicella vaccine would be a good idea. If you live in a household with babies or young children who are going to be getting vaccines, make sure they receive the inactivated form (an injection) of the polio vaccine rather than the oral type, which contains a live virus that could be dangerous for you.
Hug Your Loved Ones... Cautiously
While we’re on the topic of children, it’s important to remember that anyone with a low WBC will want to avoid contact with human feces, so it’s not a good idea to be changing diapers. Since kids are prone to colds and other infections, make sure you aren’t exposing yourself to a child that doesn’t feel well, or is coming down with a childhood disease.
And don’t forget your pets! They are a great source of comfort for many people while going through treatment, but it’s highly important that you make sure to wash your hands after petting them. This is not a good time to think about adopting a cat since chemotherapy patients with a low WBC are at greater risk of developing a disease caused by Bartonella, which is known by a more common term – cat scratch fever.
If you happen to like your pets scaly, slimy, or slithery – you’ll want to remember that contact with reptiles such as snakes, lizards, and turtles should be limited because of the danger of salmonellosis. You should also avoid cleaning fish tanks because of the possible exposure to Mycobacterium marinum.
Even birds can present a danger, especially if imported from another country, so you will want to make sure your fine feathered friends have a clean bill of health too!
People with low WBC should also avoid farm or barnyard environments where hay or other stored grasses and grains are prevalent since they may house molds and other fungus you don’t want to be breathing. Camping, fishing and or swimming present their own set of health concerns. Even hot tubs and saunas should be avoided during times when your immune system is below par.
Accept Help... To Recuperate Well
In reviewing all of these “don’ts” it seems pretty clear that you may just want to use this time to sit back and let other people wait on you hand and foot (as long as they are clean hands and feet!), so you can recuperate without risk of infection. Although they say that regular dusting, sweeping, window washing, and bathroom cleaning are okay if you are feeling well, this may be the time to tell a little white lie and have someone else perform those chores too!
In all seriousness, having a low WBC can feel about as debilitating as any illness you’ve ever experienced. Many women say they didn’t realize until they had blood work done that their WBC was low – but they knew something was wrong because they felt so awful. It’s not uncommon for someone with a low WBC to feel like they have a really bad case of the flu. Your body may ache from head to toe. You may feel like you just want to sleep, regardless of how much rest you’ve had. You may feel weak, dizzy, and generally depressed.
Talking to your doctor about what you are feeling is very important both to prevent infections from developing, and so that you will feel as well as possible while undergoing chemotherapy. Most people suffering from a low WBC generally feel better quickly with the appropriate treatment.