Low Blood Counts

Related: Low red blood cell count, Low white blood cell count, Low platelet count, Infection-prevention guidelines for immunosuppressed patients.

Other words you may hear:

• Myelosuppression - a decrease in the production of blood cells, which may lead to low blood count.
• Pancytopenia - a lowering of all three types of blood cells; red blood cells, platelets, and white blood cells, which may lead to low red blood cell count, low blood platelet count, and/or low white blood cell count.
• Anemia - a decrease in the number of red blood cells (RBC), which may lead to low red blood count.
• Thrombocytopenia - a decrease in the number of platelets (PLT), which may lead to low blood platelet count.
• Leukopenia - a decrease in the total number of white blood cells (WBC), which may lead to low white blood cell count.
• Neutropenia - a decrease in the number of neutrophils, one type of white blood cell, which may lead to low white blood cell count.
• Granulocytopenia - a decrease in the number of granulocytes, the group of white blood cells that include neutrophils, basophils and eosinophils, which may lead to low white blood cell count.

What Are Low Blood Counts?

Many of the chemotherapy drugs temporarily stop cells from dividing, especially the cells that divide quickly. Blood cells; red blood cells, white blood cells and platelets are made by the bone marrow. These blood cells divide quickly. Chemotherapy may lead to low blood counts, causing the possibility of a variety of symptoms. The symptoms depend on the type of low blood cell count.

Low White Blood Cell Count

(low WBC)

Leukopenia - A decrease in the total number of white blood cells, which may lead to low white blood cell count.

Neutropenia - A decrease in the number of neutrophils, which may lead to low white blood count.

Granulocytopenia - Some people use this term in place of Neutropenia.

White blood cells fight infection. The white blood count (WBC) is part of a complete blood count (CBC) that is used to check your blood counts. There are several types of white blood cells. A differential test will show more detail about your white blood cell count:

Normal Adult Values White Blood Cell Total 4-11 k/ul    Lymphocytes 22-44%    Monocytes 0-7%    Granulocytes          Neutrophils 40-70%         Eosinophils 0-4%         Basophils 0-1% Note: Normal values will vary from laboratory to laboratory.

When you have a low white blood cell count there is an increased risk of infection. The level of risk depends on several factors:

• How low your white blood count falls
• How long your white blood count is low
• Which type of low white blood cell count you have
• Other medications you may be taking such as steroids or immunosuppressive agents (cyclosporin).

One measure of risk is the absolute neutrophil count (ANC). The ANC is calculated by multiplying the total white blood count by the percent of neutrophils (also called segmented neutrophils, segs, polymorphoneucleated cells or PMNs, polys)

Total white blood count x % neutrophils* = ANC

* Neutrophils may be reported as segs & bands (a band is slightly less mature form of a seg). In this case add the % of segs to the % of bands then multiply by the total number of white blood cells.

(% segs + % bands) x Total white blood count = ANC

Risk of Infection based on Absolute Neutrophil Count (ANC) ANC greater than 1500 No increased risk of infection ANC 1000-1500 Slight increase in risk of infection ANC 500-1000 Moderate increase in risk of infection ANC 100-500 High risk of infection ANC less than 100 Extremely high risk of infection

Things you can do to reduce your risk of infection when you have low white blood count:

• Frequent hand washing of both you and those coming in contact with you.
• Avoid contact with anyone who is sick. If someone in the home is sick limit contact and consult your doctor or nurse.
• Do not have dental work done while your white blood cell count is low.

When your white blood cell count is low you may NOT have the usual signs and symptoms when developing an infection such as:

• Redness
• Swelling
• Pus formation (at the site of an injury or incision)
• Cough
• Sputum
• Nasal drainage (from a sinus or respiratory infection)

Therefore, it is extremely important to be alert to any change in how you feel and report and discuss what you are feeling with your doctor or nurse.

When to call your doctor or health care provider about low blood count:

Call immediately if you have:

• A temperature greater than or equal to 100.5°F. (Check with your health care provider, you may be instructed to call for temperature greater than or equal to 100°F)
• Chills (rigors) or shakes
• Sudden onset of a new unexplained pain.

Call within 24 hours if you experience the following:

• Sore throat
• Sores in your mouth
• A white coating in your mouth, especially your tongue
• Signs of a bladder infection
• Burning with urination
• Blood in your urine
• Needing to urinate more frequently than normal
• Having to urinate in a hurry and possibly not making it to the bathroom in time.

Your doctor or health care provider may prescribe or suggest to treat low white blood cell count:

• The following medications may be given after each cycle of chemotherapy to prevent your white blood cells from falling too low and/or for too long.
• Filgrastim (Neupogen^®)
• Pegfilgrastim (Neulasta^®)
• Sargramostim (Leukine^®)
• The following are antimicrobial medications that may be prescribed to prevent specific infections that are common when the immune system is suppressed by chemotherapy and/or other medications.
• Sulfamethoxazole - trimethoprim
• Acyclovir
• Fluconazole
• Itraconazole
• Other antibiotics or antimicrobials are used to treat specific infections as needed.

Note: We strongly encourage you to talk with your health care professional about your specific medical condition and treatments. The information contained in this website about low blood count and other medical conditions is meant to be helpful and educational, but is not a substitute for medical advice.