Neutrophil count down, infection risk up

A: Neutropenia is defined as a neutrophil count of less than 1,000 cells/mm3 (normal: 2,500 to 6,000 cells/mm3). Infection risk increases as the neutrophil count decreases. Less than 500 cells/mm3 is considered profound neutropenia; these patients have the highest risk of infection.Figure: Q: How do I best care for a patient with neutropenia?Neutropenia can be caused by either the lack of progenitor myeloid cell production in the bone marrow or the destruction of neutrophils elsewhere in the body. Blood disorders; tumors, such as acute leukemias, lymphomas, and aplastic anemia; and chemotherapy, radiation, and biotherapy agents are direct causes of neutropenia. Some medications, such as antiepileptics and antipsychotics, can also cause neutropenia. Medication-related neutropenia may resolve over time when the medication is discontinued or the dosage reduced. Neutropenia is an expected adverse reaction of cancer treatment and is usually reversible. However, treatment may be seriously compromised by profound neutropenia. If left untreated, the consequences of neutropenia can be sepsis, prolonged hospitalization, and even death from infection. Most patients recover neutrophil counts in a predictable way, either from cancer treatment discontinuation or from treatment of the disease that's causing the neutropenia. But the longer neutropenia lasts, the greater the risk of infection. For some patients, growth factors are an option to increase neutrophil counts and decrease the length of time they're especially vulnerable to infection. A patient with neutropenia may or may not have typical signs and symptoms of infection. Know which patients are at risk for neutropenia and assess and monitor them carefully. All wounds and catheters require careful monitoring because they're frequent sources of infection, but remain alert to subtle changes as well. Patients may complain of not feeling well, dizziness, increased fatigue, sore throat, difficulty swallowing, and urinary or bowel changes—all signs that can herald infection. Febrile neutropenia requires immediate action, so notify the healthcare provider at once. Be prepared for blood and urine cultures to be collected, and for empirical antibiotics to be started. A delay in treatment can increase the incidence of sepsis in neutropenic patients. Teach patients to: avoid exposure to sick individuals and those who've recently received live vaccines wash any fruits and vegetables carefully wash their hands often, especially before eating and after toileting immediately report a fever greater than 100.4° F (38° C) to their healthcare provider report headache, facial tenderness, sore throat, mouth sores, fatigue, or pain with or without fever report any symptoms of infection, such as tenderness, erythema, or discharge at any wound or I.V. site report any bowel or bladder changes or vaginal discharge or itching. Careful teaching will help protect patients both in the hospital and when they return home.