Chemotherapy and Low White Blood Cell (WBC) Counts

Man coughing, at home
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How does chemotherapy affect white blood cell count?:

Chemotherapy kills fast dividing cancer cells. It also ends up killing some fast dividing normal cells in the body, like some cells in the bone marrow that maintain the supply of white cells in the blood. White blood cell counts (WBC, also called leukocyte counts) fall temporarily with most chemotherapy drugs.

When does the white cell count fall?:

The fall in white blood cells starts a few days after chemotherapy is administered. They reach the lowest levels in the second or third week after chemotherapy. As the bone marrow cells recover from the effects of chemotherapy, the WBC counts start rising again. Before each cycle of chemotherapy, blood counts are verified to ensure that they have returned to the normal range.

Are low white blood cell counts dangerous?:

White blood cells are responsible for protecting the body from infections. When WBC counts are low, there is an increased risk of infections. These infections cannot be easily controlled by the body because of the low counts.

However, low counts do not always lead to infections. Nearly all people on chemotherapy have low counts during chemotherapy. But only a few people develop infections.

How do doctors check for low WBC counts?:

At regular intervals during chemotherapy, the doctor will advise blood tests to check cell counts.

These tests are called ‘CBCs’ or ‘Hemograms.’ White blood cell counts are reported as Total Leukocyte Counts (TLCs). TLCs count the different types of white blood cells. A more specific count is the Absolute Neutrophil Count (ANC). Neutrophils are one type of WBC. They are responsible for controlling bacterial infections.

When the ANC is below a particular value, doctors may delay further chemotherapy and start medications to prevent or treat infections.

What are the signs of infection during chemotherapy?:

The most tell-tale sign of infection is fever. When fever occurs in the presence of low neutrophil counts (ANC), it is called febrile neutropenia. Other signs of infection are:

  • cough and expectoration
  • loose stools
  • boils or abscesses
  • a severe sore mouth and swallowing problems

Contact your doctor immediately if you have any of these symptoms and signs during chemotherapy.

How can infections be prevented when counts are low?:

A few simple steps can reduce the chances of infections:

  • Avoid extremes of temperature
  • Make sure that the food is freshly cooked
  • Remember to wash hands before meals
  • Avoid contact with people who have any infections
  • Avoid crowded places with poor ventilation

Antibiotics are not routinely indicated when counts are low but no signs of infection are present. The decision to start antibiotics rests on your doctor, based on specific signs and risk factors.

How are low white blood cell counts managed?:

In the majority of cases, low counts are temporary. Counts start rising soon and reach normal levels without causing infections, and further chemotherapy may be continued.

When the blood counts are too low or there is a hint of infection in the body, doctors may:

  • Delay further chemotherapy until the counts are normal.
  • Start drugs that increase white blood cell counts. These are called colony stimulating factors (CSF). G-CSF and GM-CSF are the two types of CSF available.
  • Start treatment with antibiotics if there is any sign of infections in the body.

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