Neutropenia, anemia, and thrombocytopenia are common complications associated with cancer and cancer treatment. In this article, we cover the definitions and lab values associated with these conditions, as well as some important nursing care and patient teaching tips you need to know.
These conditions and their nursing precautions and patient teachings are covered in our Medical-Surgical flashcards (Immune system), and Cathy’s videos follow along with the cards.
Medical-Surgical Nursing - Flashcards
Neutropenia
Neutropenia is a condition marked by insufficient numbers of neutrophils. Neutrophils are the most common of the five types of white blood cells and their approximate normal range is between 2,500 - 8,000/mm³.
When a patient has a low white blood cell count, their immune system is at risk.
The approximate normal range for neutrophils is between 2,500 - 8,000/mm³. Neutrophil counts below 2500/mm³ can indicate neutropenia.
Neutropenic nursing care and hospital precautions
You may be familiar with contact precautions in a hospital setting. Contact isolation usually occurs when a patient has a high-risk communicable disease (e.g., MRSA) and healthcare professionals must don protective clothing and gear to protect themselves from contracting the disease from the patient.
Neutropenic precautions, or the precautions taken when you have a patient with neutropenia, are essentially the opposite. Neutropenic precautions require healthcare professionals to don protective clothing and gear to protect the vulnerable, immunocompromised patient. The imperative is to ensure that this patient does not become sick.
Nursing care
In addition to neutropenic precautions, if you have a patient with neutropenia, you will also follow other important nursing care steps.
Carefully monitor the patient’s temperature. It’s important if they have a fever to act fast.
Restrict visitors who are ill, because there is a greater risk that this patient could contract an illness from them than from a healthy visitor.
Do not keep any fresh plants or fresh flowers in the patient's room, as they can contain potentially dangerous microorganisms.
Keep dedicated equipment, like a vital signs monitor, in this patient’s room. You do not want the equipment roaming from room to room and possibly infecting the patient.
Medications for neutropenia
The medication for neutropenia is called filgrastim. Filgrastim works by causing bone marrow to increase the production of neutrophils. Filgrastim is one of the key medications covered in our Pharmacology Flashcards for Nursing Students.
Neutropenia patient teaching
A patient with neutropenia will need some specific instruction before they are discharged, including:
- Take their temperature daily and report any temperature greater than 100° to their provider.
- Avoid crowds
- Avoid sick people
- Do not consume raw foods. Raw foods carry a greater risk because the bacteria or contaminants have not had a chance to be killed off in the cooking process.
- Avoid yard work or gardening. This is the same principle as disallowing flowers and plants in the patient’s hospital room, as plants may contain dangerous microorganisms.
- Avoid changing the cat litter box, as this is a very bacteria-filled area of the home.
- Wash their dishes in hot water or in the dishwasher so the dishes can be sterilized.
- Wash their toothbrush in the dishwasher daily, or use a bleach solution. This helps ensure the toothbrush stays as clean as possible.
Anemia
Anemia, a condition marked by decreased red blood cell counts, is another common side effect with cancer treatments like chemotherapy and radiation.
Normal red blood cell count is between 4.2 - 5.4 million/uL for women and 4.7 - 6.1 million/uL for men. Red blood cell counts lower than those ranges can indicate anemia.
You may hear anemia used synonymously with “low iron,” but they are not exactly synonymous. Anemia just means low red blood cell counts, and one common type of anemia is iron-deficiency anemia, which can be checked by measuring actual iron levels, and/or by measuring the hemoglobin levels in the blood (which is not the same as the iron levels in the blood, but it is used as a proxy measure for iron).
Hemoglobin
Normal hemoglobin levels for women are between 12 - 16 g/dL and for men, 14-18 g/dL. Low levels of hemoglobin can indicate anemia.
Both red blood cells and hemoglobin lab value ranges are covered in our Lab Values flashcards for nursing students.
Medications
The medication given for anemia is called epoetin alfa, which works by stimulating bone marrow to increase the production of red blood cells and is very similar to the natural substance in your body (erythropoietin) that prevents anemia.
Another supplement that can help anemia is ferrous sulfate, which is an iron supplement. Iron is an essential component needed for hemoglobin, and iron helps the body to make healthy red blood cells.
Patient teaching for anemia
A patient with anemia should receive some specific instructions for their condition.
- Increase their intake of foods high in iron folate and B12 (leafy green vegetables, nuts, red meat, fish).
- Take extra rest periods and practice patience—anemia can cause dramatic fatigue.
Thrombocytopenia
Thrombocytopenia, a condition marked by decreased platelet counts, is another common side effect of chemotherapy. Because platelets help the blood to clot, the lack of platelets seen with thrombocytopenia puts a patient at a very high risk for bleeding.
The expected range for platelets is between 150,000 - 400,000 mm³, and levels lower than that can indicate thrombocytopenia.
Nursing care
There are several nursing care practices and precautions to remember if you have a patient with thrombocytopenia.
Monitor for blood in the patient’s stool, urine, or vomit. Internal bleeding is never a good thing, but it is especially risky for these patients.
Avoid IVs and injections whenever possible, because these are opportunities to bleed. When it is not possible to avoid IVs and injections on a patient with thrombocytopenia because a blood draw or injection is required, hold prolonged pressure over the area to ensure that the patient stops bleeding.
Implement falling safety precautions in this patient’s room, because if this patient falls and starts bleeding, it has the potential to be fatal.
Patient teaching
A patient with thrombocytopenia will need to receive some specific patient teaching and instruction to reduce the bleeding risks associated with their condition. These important patient teaching tips include:
- Use a soft toothbrush. A hard toothbrush can poke holes in gums and cause bleeding.
- Avoid blowing their nose vigorously, which could lead to a ruptured blood vessel.
- Avoid taking NSAIDs, like ibuprofen, because they carry a risk of GI bleeding, which is particularly dangerous for this patient.
- Avoid falling whenever possible. Patients do not normally try to fall, of course, but if they are instructed to avoid activities that could lead to falling because they could have fatal bleeding, then that will help them know to avoid activities like walking on ice or frost, wearing low tread shoes, or reaching for something in a risky way.
Cathy’s teaching on cancer treatment and complications is intended to help prepare you for Medical-Surgical nursing exams. The Medical-Surgical Nursing video series is intended to help RN and PN nursing students study for nursing school exams, including the ATI, HESI and NCLEX.