What Are Neutropenic Precautions?

Medically Reviewed by Melinda Ratini, DO, MS on June 02, 2021

If you've been told you have neutropenia, you should become familiar with best practices for protecting yourself against infection. This article provides much of the background and self-help information that you may need.

Neutropenia is a condition where your blood has low amounts of white blood cells called neutrophils. These cells are responsible for fighting infections. 

When your neutrophil count is extremely low, you have a high risk of getting an infection that your body can’t fight. Neutrophil blood counts per microliter of blood are as follows:

  • Normal: 2,500 to 6,000
  • Mild neutropenia: 1,000 to 1,500
  • Moderate neutropenia: 500 to 1,000
  • Severe neutropenia: 500 or less

Causes of Neutropenia

Some diseases and treatments can bring on neutropenia. They include:

  • Radiation
  • Chemotherapy
  • HIV
  • Hepatitis
  • Cancer
  • Autoimmune diseases such as rheumatoid arthritis
  • Medication for overactive thyroid
  • Some antipsychotic medication

Neutropenic Precautions

Neutropenic precautions are important preventive steps you need to take while you have neutropenia. They will help you prevent infection when you don’t have a strong immune system. This is particularly important if you're going through chemotherapy, because getting an infection can delay your treatment.

Neutropenic precautions include:

Medications. If you have neutropenia, your doctor might give you medication to stop an infection before it starts. This is called prophylactic treatment. These medications can include antibiotics and blood cell growth factors that will help you grow more white blood cells. It’s important to take these medications as prescribed.‌

Handwashing. Clean your hands often, especially after being around others or in public spaces. Wash your hands with soap and water for 20 seconds. ‌

Avoiding sick people. If friends or family or even passersby show signs of sickness, stay away. Avoid people who have contagious diseases such as chickenpox, measles, the flu, or even a common cold.

It’s a good idea to stay away from crowds. If you can’t avoid a crowd, wear a face mask.‌

Avoiding the recently vaccinated. Some vaccines contain live viruses. People who have just received such vaccines can be contagious and can spread a virus to you. Avoid people, including children, who recently got any live vaccines, including the MMR (measles, mumps, and rubella) vaccine or chickenpox vaccine.

Washing food. Thoroughly wash fruits and vegetables to rid them of bacteria. Make sure meat is fully cooked, and reheat any leftovers to the right internal temperature.

Maintaining a healthy diet. Eat a high-protein, high-calorie diet and drink plenty of water every day. Your doctor might want you to avoid eating shellfish and eggs to avoid bacteria.

Practicing good hygiene. Bacteria can enter any small cut or scrape on your skin. Make sure to shower daily and keep your skin clean. 

Keep your armpits, groin, and feet free of moisture to avoid fungal or bacterial infections. Thoroughly clean your rectal area after using the toilet. 

Moisturize dry skin to prevent any cracking or sores where bacteria can enter.  Don’t squeeze or pop pimples or scratch your skin where bacteria can spread. ‌

Brushing your teeth. Clean your teeth and mouth after eating. 

Avoiding cuts. Use an electric shaver instead of a razor. Be careful not to cut yourself while cooking or trimming your nails. Use an antibacterial cream such as Polysporin on any cuts right away.

Not cleaning pets. Let someone else clean up after pets. Don’t change the litter box or clean the fish tank or birdcage. 

Not changing diapers. If you have children, let someone else take care of the diapers. Stools have a lot of bacteria. 

When to Start Neutropenic Precautions

Once your doctor sees a need to monitor your blood count, they'll let you know if you are neutropenic. They'll tell you when you should start taking precautions.‌

If you are going through chemotherapy, you may see neutropenia start seven to 12 days after the treatment starts. You should start neutropenic precautions at this time unless your doctor tells you otherwise.

What to Do When Precautions Aren't Enough

Continue to watch for signs of infection. Even a minor infection can make you very sick. 

Signs and symptoms of infection include:

  • Fever of 100.4 degrees Fahrenheit or higher for longer than 1 hour
  • A one-time temperature of 101 degrees Fahrenheit or higher
  • Chills and sweats
  • Stuffy nose
  • Sore or stiff neck
  • Sore throat
  • Mouth sores
  • New cough
  • Worsening cough
  • Redness or swelling anywhere
  • Throwing up
  • Diarrhea 
  • Stomach pain
  • New pain
  • Burning pain while peeing 
  • Shortness of breath
  • Changes in your skin

If you have any signs of infection, call your doctor right away. If you go to the emergency room, make sure to tell them if you’re receiving chemotherapy or other immune system treatments and you have a fever. You should not sit in the waiting room of the emergency department for a long time. 

WebMD Medical Reference



CDC: “Neutropenia and Risk for Infection.”

Mary Bird Perkins Cancer Center: “Neutropenic Precautions.”

Merck Manuals Consumer Version: “Neutropenia – Blood Disorders.”

NHS: “Low white blood cell count.”

NorthShore University HealthSystem: “Treatment Precautions.”

University of Rochester Medical Center: “Neutropenia: A Vulnerable Time for Infections.”

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