Blood cell counts and infection risk

One of the main side effects of chemotherapy is damage to the bone marrow, which produces blood cells. A shortage of red cells (anaemia) causes tiredness and headaches. A shortage of a type of white blood cell called neutrophils (neutropenia) increases the risk of infection. Blood is taken between treatments to check that the cell counts have recovered sufficiently. Several people told us one or more of their treatments had been postponed to allow the cells longer to recover so they could withstand the next dose.

Some of the people we interviewed were given blood transfusions or erythropoetin to stimulate production of red cells (erythropoetin is now rarely used because of concerns that it may also stimulate lymphoma cells). A woman was at first told that she could not get erythropoetin on the NHS but eventually she was given weekly doses which made her feel much better. Others had injections of granulocyte colony-stimulating factor (GCSF) to stimulate production of neutrophils. Some people learned to inject themselves, others had family members taught how to do it. A common side effect of GCSF was aching bones, but one woman had so much fluid retention that her legs swelled to 'gargantuan proportions'. Another got worried about a strange feeling of 'hollowness' in her head, but then the hospital reassured her. A woman said she needed to be given lots of blood cells and platelets throughout her treatment, which eventually led her doctors to decide to remove her spleen as they thought it was absorbing all her blood products. After eight courses of different chemotherapies, this operation finally put her into remission.

People commonly said they tried to eat healthily or take exercise in an attempt to counter bone marrow damage and reduce their risk of infection; some took vitamin supplements, or were advised to eat lots of broccoli and drink Guinness for iron. Most said that during treatment they avoided people who had coughs and colds, going to public places or travelling on public transport. Due to the risk of infection it is best to avoid people who have sore throats, colds, flu, diarrhoea and vomiting, or other kinds of infection, such as chickenpox.  A woman started using face masks and said that other people tended to give her a wide berth when she wore them, which made shopping in crowds much easier.

Some people were advised to keep their homes and household linen very clean, to wash their hands a lot, wear gloves when gardening, and not to go to the dentist. A woman had an emergency tooth extraction and expected to get an infection but didn't. Other people were told to temporarily adopt a 'neutropenic' or 'clean' diet that avoided raw and undercooked foods. This was hard for people who usually ate a lot of fruit, salads and dairy produce - one woman said it was as though they had crossed all of her favourite foods off the list. One woman described having medication delivered into her lungs via a nebuliser to prevent her from catching a serious chest infection after her treatment.

Last reviewed February 2016.

Last updated February 2016.

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