Our immune system is essential for our survival. We don’t live alone on the planet and our environment is by no means sterile. In the sci-fi novel “War of The Worlds”, the writer postulates that aliens would die from a virus when they reach earth, and this will be our condition without our adaptive immune system. Your body contains bacteria roughly 10 times the number of its cells, yet clinical infections by such bacteria remain minimal. These bacteria live on the surface of our skin, in our gastrointestinal system and our reproductive organs. Our immune system consists of static barriers such as the skin and mucosa as well as adaptive components in the form of blood cells, antibodies and other chemical mediators.
Types of white blood cells
Our white blood cells form the backbone of our immunity. They are formed mostly in the bone marrow from mother cells called hemopoietic stem cells and then differentiate into different types with each type mostly responsible for a certain group of functions. White blood cells are found all over the body with the greater majority circulating in the blood and to a lesser extent the lymphatic system. They are also found in the skin, the gastrointestinal system, the respiratory tract and genital tract. White blood cell count in the blood ranges from 4000-11,000 cell per cubic microliter. The main types of white blood cells are:
- Neutrophils: They form 65-70% of white blood cells. They are the first line of defense against intruders and are more specialized in bacterial infections. Those cells are responsible for the formation of pus when certain bacteria invade our body.
- Lymphocytes: They form around 30% of white blood cells. They carry a wide variety of functions from fighting bacterial and viral infections to destroying cancerous cells. They are also responsible for the development of most autoimmune diseases.
- Eosinophils: They constitute around 2% of white blood cells. They are responsible for fighting parasites and can be responsible for the development of allergy.
- Basophils: They are the fewest among white blood cells. Their function is not well understood, but they release a wide range of inflammatory products and mediate inflammation in various ways.
- Monocytes: Monocytes form around 5% of white blood cells and their main function is to settle in different tissues, differentiate and form macrophages which are cells that eat intruders and foreign bodies.
What does it mean when I have neutropenia?
Neutropenia is a condition when your neutrophil count falls below normal levels. It is diagnosed when your physician orders a CBC (complete blood count) and finds that the number of neutrophils is less than the expected either in terms of relative percentage of neutrophils to other white blood cells or their absolute numbers. Neutropenia puts you at a higher risk of developing infections especially bacterial infections. In severe cases, such deficiency can prove life-threatening with the development of overwhelming bacterial infection, a condition known as “neutropenic sepsis”.
The severity of neutropenia is related to the degree of deficiency, the fewer the cells, the greater the risk and severity of infections. If the count falls enough, even the normal harmless bacteria living on the surface of our skin and in our gastrointestinal tract can turn against us causing what is known as “opportunistic infections”. Causes of neutropenia include:
- Bone marrow abnormalities causing decreased production of the cells from their mother cells whether as a part of a congenital anomaly or from several deficiencies of nutritional elements.
- Infections: Although white blood cell count generally rises in response to infection, some types of infections can cause a transient fall of neutrophils. They include typhoid, tuberculosis and parvovirus among others.
- Radiation exposure: Exposure to radiation greatly affects the bone marrow if given in excess. People at high risk of exposure include cancer patients undergoing radiation exposure and those working at nuclear plants.
- Drug reactions: Some drugs can cause a fall of white blood cell count especially neutrophils via various mechanisms through the bone marrow or through autoimmune mechanisms. They include chemotherapeutic agents as well as antibiotics and some anti-seizure medications.
- Autoimmune diseases: Some autoimmune diseases such as systemic lupus can manifest by deficiencies in blood cells including white blood cells.
- Cancer: Cancers such as leukemias and lymphomas can cause cellular deficiencies through the invasion of the bone marrow, impinging on the normal cells and hindering their division.
What precautions should I take if I have neutropenia?
The general state of immunocompromise necessitates careful handling of the patient and the surrounding environment. Patients are not treated similarly, and the degree of care depends on the severity of the overall condition. Severely neutropenic individuals are usually isolated at the hospital and their environment is kept as sterile as possible while the majority of mildly neutropenic individuals are not.
General considerations regarding neutropenic individuals include:
- Personal hygiene: Neutropenic individuals should pay extra care towards their personal hygiene since they can’t withstand even the normal bacterial load we are normally exposed to. Measures like frequent hand washing with antibacterial soap and avoiding touching the mouth and nose while outside ensure that the least amount of bacteria reach the respiratory system. Other measures include avoiding using towels, combs, and utensils with other individuals also reduce the risk of transmitting infections of the skin and gastroenteritis.
- Frequent tooth brushing: Brushing your teeth 2-3 times daily ensures healthy gums and reducing teeth and gum infections which can flare in neutropenic individuals. Try to use soft toothbrushes if your gum is sensitive to avoid damaging your mucosa. Do not ignore gum or teeth infection and seek medical care if they occur. Frequently use mouth wash containing hydrogen peroxide to keep the bacteria in your mouth to a minimum.
- Any skin abrasion or wound should be disinfected and managed properly either by yourself if minor or by healthcare personnel if it occurred with exposure to mud or rusty objects.
- Practice safe sex: Always use protection during sex and avoid multiple sexual partners during the period of neutropenia. Sexually transmitted diseases can be serious in neutropenia.
- When you are outside, try to avoid crowded places and practice social distancing. Crowded places are ideal for viral transmission especially by air.
- Avoid sick people especially people with respiratory illnesses. A mild illness for a normal people can be fatal in a sufficiently neutropenic individual.
Regarding diet, several measures can be taken to reduce any risk of gastrointestinal infections:
- Avoid eating outdoors as much as possible especially from less hygienic street food.
- Discard any outdated food especially canned food and milk products. Never use outdated meat products since they can contain lethal bacteria especially for the immunocompromised.
- Wash vegetables and fruits before consumption if raw to reduce their bacterial and parasitic load. If cooked, make sure they are cooked properly.
- Avoid raw meat products and cook your meat thoroughly.
- Try to avoid acidic and very spicy foods during your illness, they can irritate your mucosa especially if you have sensitive gums and facilitate gum and teeth infections. Acidic food can also facilitate tooth caries.
- Always consume pasteurized milk products.
When to worry?
Neutropenia is not a condition to be ignored and a neutropenic person should always be on the lookout for danger signs or “red flags”. An infection is bad, but a missed infection can be fatal. Danger signs to look for include:
- Fever, chills and a general sense of malaise: those are signs of infection and even though neutropenic individuals can have hidden infections which show no fever, fever is almost always a dangerous sign in neutropenic individuals and seeking medical care is necessary especially if fever is more than 38 Celsius.
- Diarrhea and vomiting: They are signs of gastrointestinal infections.
- Burning sensation during micturition, frequent visits to the bathroom with little voiding: They are usually signs of urinary tract infection.
- Skin rashes
- Difficulty breathing and chest pain: Although chest pain has many diagnoses, its association with difficulty breathing could point out to pneumonia.