A nurse is caring for a client who has bladder cancer and a WBC count of 900

• Overview
• Possible Causes
• Care and Treatment
• When to Call the Doctor

White blood cells are created in bone marrow and are a part of the immune system. White blood cells help the body identify and fight a variety of diseases and infections. The human body produces about 100 billion white blood cells each day.

There are five major types of white blood cells:

• Basophils
• Eosinophils
• Lymphocytes
• Neutrophils
• Monocytes

Who is likely to have a low white blood cell count?

A low white blood cell count can occur in anyone. The number of white blood cells in the body can vary, depending on a person’s age, race, and gender, and if he or she has certain medical conditions.

People who are undergoing certain treatments for cancer are likely to have a low white blood cell count.

If a person has too many—or too few—white blood cells in the body, it may mean that there is a disorder of some kind. A white blood cell count of less than 4,000 cells per microliter of blood is considered low. Sometimes a low white blood cell count is something you are born with (a genetic condition), which may or may not be a cause for concern. A low white blood cell count is associated with certain conditions, including:

• Cancer (caused by chemotherapy treatments)
• Bone marrow disorders or damage
• Autoimmune disorders (problems with the immune system in which the body attacks itself), such as lupus
• Infections (including tuberculosis and HIV)
• Immune system conditions
• Crohn’s disease
• Malnutrition
• Radiation treatments for cancer
• Rheumatoid arthritis
• Vitamin deficiencies
• Liver damage and/or enlarged spleen

To determine if a person has a low white blood cell count, the doctor will order a blood test known as a complete blood count. The doctor may order a complete blood count test on a regular basis to check on a patient who has certain conditions, such as an infection or immune system disorder. Other information from the complete blood count will help your doctor come up with a list of possible diagnoses. Your doctor may recommend a referral to a hematology specialist.

What can I do to avoid/prevent a low white blood cell count?

To minimize the chances of certain diseases and a low white blood cell count:

• Practice good hygiene. For instance, wash your hands after using the bathroom and before cooking.
• Be careful around pets and other animals that might transmit infections.
• Make sure foods are thoroughly cooked before eating them.
• Stay away from people who have infections.
• Practice safe sex; avoid drugs and sharing needles.

Ask your doctor if he or she is concerned about your white blood cell count and if you will need additional tests. If your white blood cell count is low, and you feel like you have an infection, contact your healthcare provider right away.

Last reviewed by a Cleveland Clinic medical professional on 01/12/2018.

References

• American Association for Clinical Chemistry. White Blood Cell Count. (//labtestsonline.org/understanding/analytes/wbc/tab/test/) Accessed 2/26/2018.
• Merck Manual. Overview of White Blood Cell Disorders. (//www.merckmanuals.com/home/blood-disorders/white-blood-cell-disorders/overview-of-white-blood-cell-disorders) Accessed 2/26/2018.
• National Cancer Institute. White blood cell. (//www.cancer.gov/publications/dictionaries/cancer-terms?cdrid=45993) Accessed 2/26/2018.

Get useful, helpful and relevant health + wellness information

Neutropenia is a low level of white blood cells. Because radiation therapy and chemotherapy destroy cells that grow at a fast rate, white blood cells are often affected. Patients receiving a combination of radiation therapy and chemotherapy are at greater risk for neutropenia.

Since white blood cells play an important role in preventing infection, any time your white blood cell count drops, you are at higher risk of getting an infection. Since these cells also help to fight off infections once in the body, it may be harder to get over an infection when your white blood cell counts are low. Therefore, you need to take precautions to decrease the risk of infection while receiving treatment.

Your white blood cell count will be checked periodically throughout the course of your treatments. Any time that your white blood cell count drops below 1,000 per mm3, you will be considered neutropenic. Should this happen, a nurse will review with you special steps that you must take in order to decrease the chance that you will get an infection. These neutropenic precautions are discussed below.

What Can I Do To Prevent Neutropenia?

Since white blood cells are destroyed as a side effect of chemotherapy, there is nothing specifically that you can do to prevent neutropenia from occurring. Nonetheless, there are several things that you can do to reduce your risk of getting an infection when your white blood cells are low:

If you cut or scrape the skin, clean the area immediately with soap and water and bandage as necessary.

What Are Neutropenic Precautions?

If your white blood cell count drops to 1,000 per mm3 or below, you are considered to be neutropenic. Until your count rises, it will be necessary for you to take additional measures to further decrease your risk for infection.

When Should I Call My Doctor?

Even if you have taken great care to prevent an infection, you may still become infected. If any of the following signs or symptoms of infection occur, call your doctor or nurse immediately. Do not take any medications, even aspirin or other products to lower your temperature, before talking to your doctor.

How is Neutropenia Treated?

Growth Factors

One of the most significant advances in the past decades has been the development of "growth factors," which stimulate the body's production of specific substances. One growth factor stimulates the growth of white blood cells and is used frequently with cancer patients, especially those receiving chemotherapy and radiation therapy. By increasing your body's production of white blood cells, this growth factor can decrease your risk of developing an infection.

Growth factors are administered by injection, usually 24 hours after your chemotherapy has completed.

Neulasta® Onpro® On-body Injector

An on-body injector is sometimes used so that you don't have to return to the office the next day for an injection. Your cancer care team will explain how it works and what you need to do. If you have any issues with your on-body injector, watch this video for recommended next steps.

What to Do If You Develop an Infection?

If you develop an infection, your doctor will order medications to treat the infection. Depending on the cause and severity of the infection, the medications may be given either by mouth or through a vein using an intravenous (IV) catheter. If you require IV medications, accommodations can be made for you to receive them in our office or possibly at home. Some patients require admission to the hospital in order to effectively treat their infection.

If necessary, your oncologist may decide to delay further treatments until your white blood cell count has returned to normal levels and/or you are free of infection.

Low Platelets-Thrombocytopenia

Platelets are the blood cells that help the body to form clots. This is important to prevent bleeding from cuts or other injuries. Normal platelet counts usually range between 150,000 – 400,000 per mm3 of blood. Anytime platelets drop below 50,000 per mm3, there is an increased risk for bleeding. If platelets drop below 20,000 per mm3 and there are signs of bleeding, then you may require a platelet transfusions.

There are a number of causes for low platelets. Some patients have low platelets as a result of receiving chemotherapy; others may have autoimmune diseases or blood disorders. Whatever the cause of the low platelets, there are several precautions to follow to prevent injuries that may result in bleeding.

What to do to avoid bleeding

*If you have a major injury or start spontaneous bleeding, go immediately to the nearest emergency room.