Recognize the Risk Factors for Developing Neutropenia

Patients can have multiple risk factors for developing neutropenia, including type of chemotherapy or radiation, doses, and administration schedule of the treatment regimen. Additionally, high dose density (administration of chemotherapy with less time between treatments), dose intensity (giving the maximum tolerable dose at each administration), and relative dose intensity (a percentage of the dose intensity that is given as a portion of the dose that is planned) also increase the potential for developing neutropenia.

Other risk factors include the following.

  • Preexisting neutropenia from previous cycles of treatment
  • Preexisting neutropenia as a consequence of disease
  • History of neutropenia with current or previous therapies
  • Use of highly myelosuppressive agents
  • Tumor in the bone marrow
  • Poor immune functioning
  • Malnutrition
  • Hepatic or renal dysfunction
  • Chemoradiation
  • Concurrent use of the following drugs or types of drugs: phenothiazides, diuretics, and immunosuppressive agents (Polovich, Whitford, & Olsen, 2009)
  • Comorbidities (e.g., chronic obstructive pulmonary disease, cardiovascular disease, liver or renal insufficiency, diabetes mellitus, anemia)
  • Patient factors (e.g., age > 65, female gender, poor performance status, decreased body surface area)
  • Open wounds or active infection, including mucositis (Eaton & Tipton, 2009)
References 

Eaton, L.H., & Tipton, J.M. (Eds.). (2009). Putting Evidence Into Practice: Improving oncology patient outcomes. Pittsburgh, PA: Oncology Nursing Society.

Polovich, M., Whitford, J.M., & Olsen, M. (Eds.). (2009). Chemotherapy and biotherapy guidelines and recommendations for practice (3rd ed.). Pittsburgh, PA: Oncology Nursing Society.


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