Ryan completed chemotherapy cycle 4 in March 2017. We were discharged from the Teenage Cancer Trust ward at Cardiff hospital and managed a week at home before Ryan was unfortunately admitted to Carmarthen hospital with febrile neutropenia.
Febrile neutropenia is a whole-body reaction to infection when there is a low immunity due to chemotherapy. Ryan's temperature reached 40.1C and his lymphocyte white blood cell count was 0.2. When the count falls below 1, this is called neutropenia and infections become a high risk.
Neutropenia is very common in cancer patients and we have done well to avoid an episode up to this stage. The standard oncology protocol is to spend a minimum of 48 hours on IV antibiotics and 7-10 days on growth hormone injections to support the recovery of the white blood cell count. It didn’t go quite as smoothly as this however for Ryan, but that is whole other story that will be told later. Chemotherapy is likely to cause a low white cell count - particularly neutropenia. If you or a patient you care for presents with any form of infection while undergoing chemotherapy treatment it is urgent they receive the same day full blood count and that you know to look out for the following: If neutrophils <1.0 and the patient is febrile (>38C on one occasion or >37.5C on two occasions taken half an hour apart), admission to hospital is required for IV antibiotics. If neutrophils >1.0 and the patient is febrile but well, consider oral antibiotics after checking with GP/Local Hospital/Oncology team. If neutrophils are >1.0 and the patient is febrile and clinically unwell please liaise with your emergency contact team. If you are ever unsure. Get checked. It is the age-old ‘better to be safe than sorry’ scenario. Chemotherapy is well known to lower your resistance to infections. When you have lower than normal white blood cells your body is less able to fight infections. When you are neutropenic it is strongly recommended to not spend long periods of time in crowded places, such as cinemas, shopping centres, swimming pools etc. It is also sensible to avoid close contact with any family or friends who have obvious coughs, colds, flu etc. You should take it very seriously if you do develop an infection whilst on chemotherapy and for up to four weeks after treatment. Signs of an infection are: A temperature above 38C on one occasion or above 37.5C on two occasions during a half-hour period. A sore throat. A chesty cough. An upset stomach. Needing to pee more often or pain when going. Feeling generally unwell. Redness, discharge or shivery episodes after use of Hickman or other central lines. Don’t delay seeking advice and treatment. Infections are a SERIOUS risk and can become life-threatening very quickly if ignored. Fortunately, Ryan recovered well from this latest blip and we put it down as just another bump on our badly paved trip, down Lymphoma Road.