Neutropenia means a low white blood cell count
White blood cells fight infection. A normal white blood cell count varies between 5,000 and 10,000. When the white blood cell count drops below 1,000 (referred to as less than 1.0), the risk of infection is higher. However, the total white blood cell count is only part of the whole picture.
Understanding The Differential
There are many different types of white blood cells. Each has a different job. The differential gives information on the different types of white blood cells in the child’s blood count.
- Neutrophils are cells that help to fight bacterial infections.
- Lymphocytes make antibodies.
- Monocytes help to fight infection by destroying and removing bacteria.
- Basophils and eosinophils respond during an allergic reaction.
The total number of neutrophils present in a child’s blood following treatment is a very important number. This number is called the ANC or Absolute Neutrophil Count. The lower the ANC, the greater the risk of infection. When the ANC drops below 500, the risk of infection is high. To calculate the ANC, multiply the number of neutrophils (listed as neuts, or commonly divided into segs and bands) listed on the differential by the white blood cell count.
(% segs + % bands) x WBC = ANC
For example: (20% + 1%) x 10,000 = 2,100 (0.21 x 10,000) = 2,100
On most blood count reports, the ANC is already calculated for you.
Signs of a low white blood cell count
While there are no outward signs of a low white blood cell count, it's important to be aware of the timing of low blood counts following chemotherapy. (Whenever a child receives chemotherapy, it is helpful to speak with the nurse about the timing of low counts). Children who develop fever or infection while experiencing a low white blood cell count (neutropenia) must be given medical attention promptly.
Fever
A fever may be a sign of a serious infection. If the child has a fever, call the child's doctor right away. Children who receive cancer treatment are at high risk for a serious infection in the blood known as septicemia or "sepsis." A child with a low ANC and fever must get medical treatment immediately. This can be a life-threatening illness that can quickly turn into a medical emergency. Anytime the child has "chills" and does not look well, call the doctor right away, irregardless of the time of day.
Signs of infection
Call the doctor or nurse immediately if you see any signs of infection. If the child has a fever or pain (earache, sore throat, headache, pain with urination or having a stool), he or she may have an infection. If the child has a central venous access device (central line or port), check for redness, swelling, pain or pus at the site. If you see any of these signs, call the doctor right away.