What You Need To Know About Living With Low White Blood Cells

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White blood cell (WBC) counts may fall due to many different things, including the blood cancers known as leukemia, lymphoma and myeloma—as well as their treatments.

When levels fall, precise counts of one WBC type in particular, the neutrophils, tend to be very good at predicting a person’s risk for infection. Doctors use the absolute neutrophil count to measure neutrophil levels, and when they are too low, this is called neutropenia.

If counts fall even further, the condition may be categorized as severe neutropenia.

Why the Low Counts?

If the cancer cells are crowding out normal white-blood-cell-producing cells in your bone marrow, this can result in low counts. Or, it may be a side effect of therapy for your cancer, such as chemotherapy or radiation. Often in cancer patients, low WBC counts reflect suppression of your bone marrow, and so it’s not just the neutrophils that are low, but also other cells made by the marrow—other white cells, red cells and the platelets that help the blood to clot. 

Your doctor will follow your WBC count closely, but if you are at risk for infection due to low counts, there are also some things you need to know and a few things you can do to help minimize your risk.

How to Decrease Your Chances of Getting an Infection

There are a number of things you can do to help prevent an infection:

  • Perform good handwashing several times a day, especially before and after eating or food preparation, after using the toilet, or after sneezing or blowing your nose.
  • Perform good mouth care.
  • Wear gloves when working with soil or out in the garden.
  • Use an electric razor instead of a straight blade.
  • Avoid large crowds, or people who have recently been sick.
  • Take care of your skin, and clean any cuts or scrapes with soap and water immediately.
  • Avoid scratching or picking at pimples.
  • Do not clean or scoop cat litter boxes or birdcages.
  • Cook all meats and fish well, and wash all fruits and vegetables before eating them.
  • Avoid taking rectal suppositories or enemas. Keep an eye on your bowel patterns and intervene before you become constipated.
  • Ask your healthcare provider about immunizations or flu shots.
  • Avoid contact with children who have recently received a live vaccine such as chicken pox, measles, or polio.
  • Change towels and hand towels often.
  • Do not share drinks or eating utensils with others.
  • Do not have plants or fresh flowers in your hospital room.
  • For the ladies, use sanitary napkins instead of tampons during your period and avoid vaginal douches or bubble baths which may disturb the balance of normal vaginal organisms

In some cases, a virus that is lying dormant in your body may cause infection. An example of this may be the herpes virus that causes shingles. These viruses, if not being kept in check by your immune system, may become reactivated and lead to an infection.

Signs of an Infection

In patients with low WBC counts, infections can come on suddenly and progress quickly. Some common signs of an infection are:

  • Fever with a temperature greater than 100°F or 38°C
  • Sweating, especially at night
  • Pain with urination, or frequently voiding small amounts
  • Chills or shaking
  • Cough that produces green or yellow sputum
  • Sore throat
  • Redness and swelling at a skin wound
  • Diarrhea

If you are neutropenic, the usual signs that accompany an infection may not be present. Redness, swelling and pus are responses that are created, in part, by white blood cells, and if your counts are low, those signs may not be present. Fever may be the only symptom that you have and should be taken seriously after cancer treatment.

It is important that you have a good working thermometer at home, and know how to use it properly so you can detect a fever early.

Treatment of Neutropenia and Infection

In most cases, your healthcare provider will expect that your treatment will cause a certain amount of neutropenia. However, the longer your immune system is out of order, the more likely you are to get a serious infection. Therefore, your doctor may order a type of drug called a colony-stimulating factor.

Bone marrow stimulators such as G-CSF (Filgrastim, Neupogen or Neulasta) or GM-CSF (Sargramostim, Leukine), give your bone marrow a message to start producing white blood cells again. These medications are given as an injection and are often started shortly after treatment, or once your white blood cell count has been low for a couple of days.

Your doctor may also choose to start you on prophylactic or preventive antibiotics or antivirals; that is, medications to prevent infection from happening. A variety of factors are considered and there are standards that help guide doctors on the decision to treat preventively with antibiotics or not.

A Word from Verywell

Although neutropenia is a common side effect following treatment for leukemia or lymphoma, it can also become very serious and even life threatening if a severe infection develops. It is important to prevent infection and keep on the lookout for signs and symptoms when your counts are low. Treat your fever as an emergency, and contact your healthcare provider right away if you think you have an infection.


Ryan, J. Infection. In Yarbro, C., Frogge, M., Goodman, M., Groenwald, S. eds(2000) Cancer Nursing: Principles and Practice, 5th ed. Jones and Bartlett: Sudbury, MA. (pp.691- 708)

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