Key points to remember about low white cell count and infection during chemotherapy

This page is part of a whole section about childhood cancer [1].

• low white cell count is called neutropenia
• white cells fight infection
• neutropenia leads to increased infection risk
• infection in a neutropenic child can become serious quickly
• call your child's doctor or nurse if your child is neutropenic and has a temperature of 38 degrees Celsius or higher
• it's important to remember that a normal neutrophil count does not necessarily mean your child has normal infection-fighting ability (normal immunity)

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 infection risk. If your child is neutropenic and gets an infection, they can become seriously ill quickly.

A fever is a sign that an infection may be starting. If you think your child has a fever you should take your child's temperature.

You can buy a thermometer at a pharmacy, or a ward nurse may give you one. An ear (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.

It's important to remember that a normal neutrophil count does not necessarily mean your child has normal infection-fighting ability (normal immunity).

What is the best way to take my child's temperature during their cancer treatment?

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

If you have an ear (tympanic) thermometer, place it in your child's ear until it beeps. Then read the number on the small screen.

For more information about taking your child's temperature, see Thermometers - how to use them [2].

What should I do if my child has a temperature during their cancer treatment?

If your child is neutropenic and has a temperature of 38 degrees Celsius or higher, or is feeling 'not right' and you are concerned, they may have 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

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

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

If your child is receiving chemotherapy, a fever is serious because they have a low resistance to infection. Always ask for medical advice.

If your child is neutropenic and gets an infection, they can become seriously ill quickly without immediate medical attention.

If your child is neutropenic and has a temperature of 38 degrees Celsius or higher phone the hospital and tell your child's doctor or nurse.

What will happen to my neutropenic child with a fever?

If your child is neutropenic and has a fever, they will most likely need to go to hospital so they can receive antibiotics through a vein (intravenously). Intravenous antibiotics act quickly. A course of antibiotics may take several days to complete. Your child will stay in a room by themselves to protect them from other infections.

Which childhood infections are a risk to my child during their cancer treatment?

Measles and chickenpox are dangerous for a child with low infection-fighting ability (low immunity).

Check the page Measles and chickenpox in children with low resistance to infection [3].

What if my child has symptoms or has been close to an infected person during their cancer treatment?

You should phone your doctor or nurse if your child is due to go into hospital or the 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.

What about childhood immunisation during cancer treatment?

Your child should have flu immunisation [4] every year during treatment but no other immunisations.

After your child's infection-fighting ability (their immunity) has recovered, your doctor will talk with you about catch-up immunisations. Infection-fighting ability usually recovers 4 months after treatment - longer after a stem cell transplant.