Low white cell count and infection in chemotherapy

Low white cell count and infection in chemotherapy

A low white cell count is called neutropenia, and neutropenia leads to an increased risk of infection. Infection in a neutropenic child can become serious quickly. Measles, chickenpox, gastroenteritis, mumps and rubella (German measles) are a risk for your child. Tell your child's doctor or nurse if your child has gastroenteritis or has had contact with anyone with any of these diseases. 

Why do I need to watch for signs of infection in my neutropenic child?

Low white cell count is called neutropenia.

White cells fight infection. There are different types of white cells with different tasks. Two of the important types of white cells are:

  • neutrophils which help fight bacterial and fungal infections
  • lymphocytes which make antibodies and help fight viral and fungal infections

Neutropenia leads to increased risk of infection. Infection in a neutropenic child can become serious quickly.

A fever is a sign that an infection may be starting. Parents who think their child may have a fever should take their child's temperature.

A thermometer can be purchased at a pharmacy or you may be supplied one from the ward. A tympanic thermometer costs more than a digital thermometer.

Your child's doctor or nurse will tell you what to do if your child is neutropenic and has a fever.

What is the best way to take my child's temperature?

If you have a digital thermometer you place it under your child's tongue or underarm until it beeps. Then read the number in the small screen.

If you have a tympanic thermometer you place it in your child's ear until it beeps. Then read the number in the small screen.

 For more information about taking your child's temperature, see:

What should I do if my child has a temperature?

If your child is neutropenic and has a temperature of 38 degrees Celsius or higher, or is feeling 'not right' and causing you concern that there may be an infection:

  • phone the hospital and tell your child's doctor or nurse
  • ask your child's doctor or nurse before giving your child any medicine to reduce the fever
  • you can find the hospital phone number in the page you printed (Important contacts for your child with cancer) and put in your folder

Normal body temperature is between 36 degrees Celsius and 37.5 degrees Celsius.

A temperature of 38 degrees Celsius or higher is a fever.

In a child receiving chemotherapy, a fever is serious because they have a low resistance to infection. Medical advice is always required.

Medical advice is required because a neutropenic child with an infection may become ill quickly without prompt medical attention.

What will happen to my neutropenic child with a fever?

A child who is neutropenic and has a fever will usually be admitted to hospital so that antibiotics can be given intravenously. Antibiotics given intravenously act quickly. A course may take several days to complete and during the stay in hospital a neutropenic child will stay in a single room to protect them from other infections.

Which childhood infections are a risk?

The following infections are a risk to your child:

  • measles and chickenpox
  • gastroenteritis
  • mumps and rubella (German measles)

Measles and chickenpox

Measles and chickenpox which normally cause little trouble for children, are dangerous for a child receiving chemotherapy. Relatives, friends and the teachers at your child's school or pre-school need to know that you should be told if anyone your child has been close to for more than 30 minutes, has chickenpox, measles or shingles.

What can I do?

Ask your nurse to provide a letter about the risk to your child of chicken pox and measles which you can give to your friends, relatives, school or pre-school.

Tell your doctor or nurse straight away so that protective medication can be given if your child has been close to a person who has chickenpox, measles or shingles.

What's the infectious period?

The infectious period of an infection is the time during which it can be passed on to another person. Measles and chickenpox have an infectious period before the rash appears.

  • chickenpox: infectious from one to two days before the spots appear until all lesions have dried and crusted and no new ones are appearing
  • shingles (can cause chickenpox): infectious from one to two days before the spots appear until all lesions have dried and crusted and no new ones are appearing
  • measles: infectious from the first appearance of the symptoms of fever, or cough, or red eyes, before the appearance of the rash, until the last of the rash fades (usually four days from the start of the rash)

Gastroenteritis

Gastroenteritis, which is common among children, can be dangerous for a neutropenic child. Gastroenteritis is an infection in the bowel causing fever and diarrhoea (frequent, loose, watery bowel motions). There may also be vomiting. It is very catching (contagious) and can be caught by being close to a person who has the infection. The best way to stop the spread of gastroenteritis is by frequent, effective hand washing and good hygiene. See:

Gastroenteritis may cause a loss of fluid from the child's body and can lead to dehydration so the treatment is to increase the child's fluid intake. See the following for advice about food and fluids:

What should I do if my child gets gastroenteritis?

If your child has gastroenteritis:

  • phone the hospital and tell your child's doctor or nurse
  • insert the information pamphlet and any other instructions you are given, into the section of your folder about chemotherapy side effects

What if my child has symptoms or has been close to an infected person?

You should phone your doctor or nurse if your child is due to go in to hospital or day stay unit or clinic and:

  • has a rash or
  • has diarrhoea and vomiting or
  • has been close to a person with an infection

Your child's doctor or nurse may reschedule the appointment to another time and place.

Mumps and rubella (German measles)

Mumps and rubella (German measles) do not require any special precautions but you should tell your child's doctor.

What about childhood vaccinations?

Vaccinations should be discussed with the doctor of a child receiving chemotherapy treatment so that a plan can be made for after treatment is finished. A booster may be given.

Where to go for more information and support

On this website:
Childhood cancer: Where to go for more information and support

 Acknowledgements

All the fact sheets in the Childhood cancer section of this website have been written by health professionals who work in the field of paediatric oncology. They have been reviewed by the members of the National Child Cancer Network (NZ). Medical information is authorised by the National Child Cancer Network Clinical Leader.

This page last reviewed 24 April 2013.
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