Managing Neutropenia for Pediatric Patients

This information explains what neutropenia is and how to manage it after you’re discharged from your inpatient stay at Memorial Sloan Kettering (MSK) for fever and neutropenia. For the rest of this resource, the words “you” and “your” refer to you or your child.

About Neutropenia

Neutropenia (new-tro-PEE-nia) is when you have a low number of neutrophils (a type of white blood cell) in your blood. It’s common to have neutropenia after certain types of cancer treatments.

These neutrophils help your body fight infection. When you have neutropenia, you have a higher risk of getting an infection. A fever, a temperature of 100.4° F (38.0° C) or higher, is usually the first sign of an infection.

For more information about neutropenia and how to manage it, read our resource Neutropenia (Low White Blood Cell Count). For food safety guidelines to follow when you have neutropenia, read our resource Low-Microbial Diet.

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Leaving the Hospital

At the hospital, your doctor gave you intravenous (IV, through a vein) antibiotics (medication to treat and prevent infection) and a blood test. Your blood test showed that you don’t have an infection. You also haven’t had a fever in at least 24 hours. This means that it’s safe for you to leave the hospital and manage your neutropenia on your own.

Take your antibiotics

Before you leave the hospital, your doctor will give you a prescription for oral antibiotics (antibiotics that you swallow), IV antibiotics, or both. Follow your doctor’s instructions for how to take your antibiotics. If you can’t take them for any reason or forget to take them, call your doctor right away. After 5:00 pm, during the weekend, and on holidays, call 212-639-7575 and ask for the doctor covering for your doctor.

Get blood tests

When you leave the hospital, you will need to have a blood test, called a complete blood count (CBC), every day or every other day. This is to check your absolute neutrophil count (ANC). When your neutrophil count is 500 or higher, you will go back to your regular schedule of blood tests based on your doctor’s recommendations. Follow your doctor’s instructions for how often to get your blood tests.

Check your temperature

When you leave the hospital, you will need to check your temperature 3 times a day until your neutrophil count is 500 or higher. If your temperature is 100.4° F (38° C) or higher, call your doctor right away. After 5:00 pm, during the weekend, and on holidays, call 212-639-7575 and ask for the doctor covering for your doctor. You may need to go back to the hospital.

Look out for signs of infection

You will also need to check for other signs of infection. Call your doctor right away if you have any of these signs:

  • Fatigue (feeling more tired or weak than usual)
  • Shaking chills
  • Body aches
  • Sweats
  • Cough
  • Trouble breathing or feel short of breath
  • Redness, swelling, or warmth on an injury or incision (surgical cut)
  • Redness, swelling, or warmth around your central line
  • Pain in your abdomen (belly)
  • Nausea and vomiting that isn’t getting better
  • Mouth sores
  • Diarrhea (loose or watery bowel movements)
  • Pain when having a bowel movement (pooping)
  • Feeling dizzy, confused, or weak
  • Pain or burning when urinating (peeing)

If you have any of these signs, or if you have any new symptoms not listed here, call your healthcare team right away at 212-639-7575. After 5:00 pm, during the weekend, and on holidays, call 212-639-2000 and ask for the doctor covering for your doctor.

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How to Prevent Infection

Here are some ways you can prevent infection:

  • Take a shower or bath every day.
  • Wash your hands using antibacterial soap. This type of soap is better at killing germs.
    • To wash your hands, wet your hands with warm water and then rub your hands with soap for at least 15 to 20 seconds. Rinse your hands well under warm running water. Dry your hands with a clean paper towel.
  • Use an alcohol-based hand sanitizer (such as Purell®) after shaking hands and after contact with young children.
    • To use an alcohol-based hand sanitizer, cover both your hands with the hand sanitizer and rub them together until they’re dry.
  • Brush your teeth after each meal. Use an ultra-soft toothbrush.
  • Avoid having visitors who have a cold or recently had an infection.
  • Wear a mask when you go out in public places or crowded areas to help protect you from catching a cold.
  • Don’t share your forks, spoons, cups, or anything else you use to eat or drink.
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Follow-Up Appointments

You will have your first follow-up appointment the day after you leave the hospital. Your appointment will be scheduled for you. You may need to see your doctor every day or every other day until your neutrophil count is 500 or higher. Your doctor will let you know how often you will need to see them.

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Contact Information

If you have any questions or concerns, call your healthcare team at 212-639-7575. You can reach them Monday through Friday from 8:00 am to 5:00 pm. After 5:00 pm, during the weekend, and on holidays, call 212-639-2000 and ask for the doctor on call for your doctor.

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