Neutropenia. Page 1 of 6

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1 Neutropenia What is neutropenia? 1,2 Neutropenia is when you don t have enough neutrophils in your blood. A neutrophil is a type of white blood cell that s made in your bone marrow. All white blood cells help your body fight infections but neutrophils serve as the primary defense. Neutrophils fight infection in your blood by destroying harmful germs like bacteria and fungi. They usually make up about 50 to 70% of the white blood cells in your bloodstream. When you have neutropenia, you can get infections easily because you don t have enough neutrophils to destroy the harmful germs. Most of these infections can affect your lungs, mouth and throat, sinuses, or skin. What causes neutropenia? 1,2 Cancer and cancer treatments such as chemotherapy may cause neutropenia. Neutropenia occurs in about 50% of people receiving chemotherapy. It s also common in people who have leukemia. Neutropenia may also be caused by: a problem in your bone marrow that keeps new neutrophils from being formed a condition that destroys neutrophils in the bloodstream vitamin deficiency hereditary disease tuberculosis an infection caused by a virus a side effect from a medication What are the symptoms of neutropenia? 1 People who have neutropenia sometimes don t know they have it. Neutropenia may not cause any symptoms. It s generally found during a blood test. If you have neutropenia, you should keep track of any signs and/or symptoms of infection you may be having. A minor infection can quickly become serious if it isn t caught in time. Page 1 of 6

2 If you have neutropenia and have any of the following symptoms, you should get medical attention right away: A fever or temperature of 101 F or higher Chills and sweating A sore throat or sores in the mouth Abdominal pain Diarrhea that doesn t go away or sores around your anus Pain or burning when you urinate or urinating frequently A cough or breathlessness Any redness, swelling, or pain around a cut or wound Unusual vaginal discharge or itching What treatments are available for neutropenia? 3,5 Medications such as Leukine (sargramostim), Neulasta (pegfilgrastim), and Neupogen (filgrastim) are used to help your body make more neutrophils. Your doctor may prescribe these medications if you are receiving cancer chemotherapy or getting a bone marrow transplant. What are the side effects of treatment? 3,5-8 Some common and serious side effects of the medications are listed in Table 1. If you experience any of these side effects, please get in touch with your OptumRx pharmacist to discuss these symptoms further. If your symptoms are severe, contact your doctor immediately. Table 1: Common and Serious Side Effects of Medications Used for Neutropenia Medication Common Side Effects Serious Side Effects Leukine Bone pain Signs of infection: chills, sore throat, Mild fever congestion, high fever Injection site reaction Sudden weight gain or signs of fluid build-up (swollen legs or feet) Chest pain Rapid or irregular pulse Neulasta Bone pain Pain located in the upper left section of Neupogen Muscle pain your stomach area and/or left shouldertip Injection site reaction area. Shortness of breath, trouble breathing, or fast breathing Page 2 of 6

3 What can I do to make some of the side effects tolerable? Table 2 lists some tips on how to deal with your side effects. Table 2. Side Effects Management Side Effect Management Mild fever Drink plenty of fluids. Avoid alcohol and caffeine. (< F) Consider using cold compresses. Talk to your doctor regarding the use of over-the-counter medications (such as Advil, Motrin, or Tylenol ) to reduce temperatures greater than 101 F. If the fever continues or if you have other symptoms such as pain, nausea, or vomiting, please see your doctor. Bone pain Massage, relaxation, or meditation may help you relieve some of the pain. Avoid sustained activities. Talk to your doctor regarding the use of over-the-counter pain relievers such as Advil, Motrin, or Tylenol to treat your pain. Injection site reaction Allow the medication to reach room temperature before injecting. Change the injection site with each injection. Wait at least 1 week before using the same site again. Maintain an injection log to keep track of where you injected before. Avoid injecting into areas that are tender, red, or hard. Applying ice or warm compresses to the injection site may help minimize the discomfort. Talk to your doctor to see which method is best for you. Do not massage the injection site unless directed to do so by your doctor. Before using these tips, be sure to let your doctor know if your symptoms are severe. If your symptoms don t go away or get worse, please talk to your doctor right away. What other important information do I need to know? 9,5 Before starting your treatment with Neulasta or Neupogen, please talk to your doctor if you have a sickle cell disorder. Severe sickle cell crisis has been reported in people with sickle cell disease who received Neulasta and Neupogen. Some of these symptoms include sudden pain in the bones, chest, stomach, or joints. If you develop a sickle cell crisis after receiving Neulasta or Neupogen, tell your doctor right away. Page 3 of 6

4 Drugs that may increase white blood cells (such as lithium and corticosteroids) should be used with caution while receiving Leukine. Ask your doctor or pharmacist if you have any questions. How should I store my medication? Table 3 lists important storage information. Table 3. Storage Information Drug Storage Leukine Store in refrigerator at 2 8 C (36 46 F). Don t freeze or shake. Neulasta Store in refrigerator at 2-8 C (36 46 F). Don t freeze or shake. Keep drug in carton to protect from light. Neulasta can be left at room temperature for up to 48 hours. Neupogen Store in refrigerator at 2-8 C (36 46 F). Don t freeze or shake. Neupogen can be left at room temperature for up 24 hours. How do I stay healthy? 13 You must avoid infections while your neutrophil count is low. The following are tips to help you stay healthy and avoid infections: Exercise regularly but make sure to get plenty of rest. Eat a well-balanced diet that has plenty of fiber. Don t eat raw foods, including meats, shellfish, and eggs. Avoid or carefully wash raw fruits and vegetables. Make sure food is cooked adequately. Be careful using sharp objects, such as scissors or knives. Use an electric shaver to avoid cuts. Don't change cat litter or handle animal waste. Use gloves for gardening and housework. Don t share food, cups, utensils, or other personal items like toothbrushes. Wash your hands frequently, especially after using the bathroom and before eating. Shower or bathe daily. Use lotion to prevent your skin from becoming dry and cracked. Clean your teeth and gums with a soft toothbrush. Avoid crowded places and contact with people who are ill. Page 4 of 6

5 What other resources are available? For more information, please contact the following resources. OptumRx Phone: Website: American Society of Clinical Oncology Phone: Website: Look to LEUKINE Program Phone: LEUKINE Website: National Comprehensive Cancer Network Phone: Website: Neulasta Website Phone: Website: References: 1. Neutropenia. Cancer.Net Website. American Society of Clinical Oncology. Accessed December 17, Disease and Treatments: Pediatric White Cell Disorders. Mayo Clinic Website. Accessed December 17, National Comprehensive Cancer Network Website. NCCN Clinical Practice Guidelines in Oncology Myeloid Growth Factors v Accessed December 18, Smith TJ, Khatcheressian J, Lyman, GH, et al Update of Recommendations for the Use of White Blood Cell Growth Factors: An Evidence-Based Clinical Practice Guideline. J Clin Oncol :24(19): Clinical Pharmacology Website. Accessed December 18, Leukine Prescribing Information. Seattle, WA: Berlex; Neulasta Prescribing Information. Thousand Oaks, CA: Amgen; Neupogen Prescribing Information. Thousand Oaks, CA: Amgen; Sickle Cell Anemia. National Heart Lung and Blood Institute Diseases and Conditions Index Website.: Accessed December 17, Fever. American Academy of Family Physicians Website. Accessed June 29, Tips for Reducing Injection-Site Reactions. Neura.net Perspectives on CNS Disease Management Website. Accessed April 12, Page 5 of 6

6 12. Managing Pain Related to Cancer and Bone, A Publication of the Bone and Cancer Foundation. Bone and Cancer Foundation Website. Accessed June 30, Living with Neutropenia. Neutropenia Support Association Website. Accessed July 1, The information in this educational handout doesn t substitute the medical advice, diagnosis, or treatment provided by your doctor. Always seek the help of your doctor or a qualified health provider for any questions about your medical condition OptumRx, Inc. Page 6 of 6