Watching for Infection

Many cancer treatments and cancers can cause changes in your blood counts. A low white blood cell (WBC) count can put you at higher risk of infection. You may hear this called neutropenia, or be told that you are neutropenic.

The WBC count measures your body’s ability to fight infection. A normal WBC count is about 5,000 to 10,000. When your WBC count is low, you’ll need to watch for signs of infection so that you can get treatment right away.

What to look for

  • Fever (temperature of 100.5° F or higher when taken by mouth)
  • Any new area of redness, tenderness, or swelling
  • Pus or yellowish discharge from an injury or other location
  • New cough or shortness of breath
  • New abdominal (belly) pain
  • Shaking chills that may be followed by sweating
  • Burning or pain when passing urine (peeing)
  • Sore throat
  • Sores or white patches in the mouth

What the patient can do

  • Check your temperature by mouth (or under your armpit if you can’t keep a thermometer in your mouth).
  • Take acetaminophen (Tylenol) for a fever only after getting the OK from your cancer team.
  • Keep warm.
  • Take antibiotics or other medicine as prescribed.
  • Drink fluids, but don’t force more than you can tolerate.
  • Avoid anything that can cause cuts, scrapes, or other breaks in the skin.
  • Wash cuts and scrapes with soap and water every day, apply antibiotic ointment, and keep them covered until healed.
  • Wash your hands after using the bathroom or visiting public places. Use hand sanitizer when you don’t have soap and water.
  • Avoid crowds, and don’t visit with people who have infections, coughs, or fevers.
  • If you eat raw foods, wash them carefully and peel them to avoid germs.
  • Brush your teeth twice a day. Ask your doctor or nurse if it is safe for you to floss.
  • Drink 2 to 3 quarts of liquid each day, if OK with your cancer team.

What caregivers can do

  • Watch for shaking chills, and check the patient’s temperature after the shaking stops.
  • Check the patient’s temperature using a thermometer in the patient’s mouth or under the armpit. (Do not take a rectal temperature.)
  • Encourage visitors who have diarrhea, fever, cough, or the flu to visit the patient only by phone until they are well.
  • Offer extra fluids.
  • Help the patient take medicines on schedule.

Call the cancer team if the patient:

  • Has a temperature of 100.5° F or higher when taken by mouth
  • Has shaking chills
  • Feels or seems “different” to others
  • Cannot take in fluids

The American Cancer Society medical and editorial content team
Our team is made up of doctors and master’s-prepared nurses with deep knowledge of cancer care as well as journalists, editors, and translators with extensive experience in medical writing.

Fauci AS, Braunwald E, Kasper DL, et al (Eds). Harrison’s Principles of Internal Medicine, 17th ed. New York: McGraw-Hill Medical, 2008.

Camp-Sorrell D, Hawkins RA. Clinical Manual for the Oncology Advanced Practice Nurse, Second Ed. Pittsburgh: Oncology Nursing Society, 2006.

Cope DG, Reb AM. An Evidence-Based Approach to the Treatment and Care of the Older Adult with Cancer. Pittsburgh: Oncology Nursing Society, 2006.

Houts PS, Bucher JA. Caregiving, Revised ed. Atlanta: American Cancer Society, 2003.

Kaplan M. Understanding and Managing Oncologic Emergencies: A Resource for Nurses. Pittsburgh: Oncology Nursing Society, 2006.

Kuebler KK, Berry PH, Heidrich DE. End-of-Life Care: Clinical Practice Guidelines. Philadelphia: W.B. Saunders Co. 2002.

National Comprehensive Cancer Network. Palliative Care. Version 1.2015. Accessed at www.nccn.org/professionals/physician_gls/pdf/palliative.pdf on March 19, 2015.

National Comprehensive Cancer Network. Prevention and Treatment of Cancer-Related Infections. Version 2.2014. Accessed at www.nccn.org/professionals/physician_gls/pdf/infections.pdf on March 19, 2015.

Oncology Nursing Society. Cancer Symptoms. Accessed at www.cancersymptoms.org on April 3, 2013.

Ripamonti C, Bruera E. Gastrointestinal Symptoms in Advanced Cancer Patients. New York: Oxford University Press, 2002.

Varricchio CG. A Cancer Source Book for Nurses, 8th ed. Sudbury, MA: Jones and Bartlett, 2004.

Yarbro CH, Frogge MH, Goodman M. Cancer Symptom Management, 3rd ed. Sudbury, MA: Jones and Bartlett, 2004.

Last Medical Review: July 23, 2015 Last Revised: February 10, 2017

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