What is Neutropenia and Why I Should Follow a Neutropenic Diet

by Jane Ashley

If you were like me, you’ve never heard of neutropenia (pronounced noo-troe-PEE-nee-uh). When I went in for my fourth chemotherapy infusion, my oncologist came in after receiving my lab results. She was always upbeat and had a smile on her face. She said, “No chemo for you today!”

What Is Nutropenia And Why I Should Follow A Neutropenic Diet

I thought to myself, “No chemo? I want/need to have my chemo.” That which I first feared had become my friend. Already, I understood that chemo was an integral part of my treatment.

She explained, “Your neutrophil count was dangerously low.” 

The normal range for neutrophils (a white blood cell that fight infections, particularly from bacteria) is between 1.5 and 8.0/mm3. What this means is the real world is that a patient has 1,500 to 8,000 per microliter of blood. My neutrophil count that day was 0.3, meaning that I had just 300 of these essential little white cells per 4.1667 cups of blood. YIKES! That was a very low count.

My oncologist called me in a prescription for antibiotics, advised me to eat a neutropenic diet and come back the next Monday to check my blood counts. “If they’ve recovered, we can do chemo.”

What causes neutropenia?

Strong chemotherapy is the major cause of neutropenia in cancer patients. Chemotherapy targets fast-growing cells like cancer cells, but unfortunately, our chemo also kills some of the good cells – fast-growing cells like our blood cells and hair follicles. 

Neutropenia Facts

Most patients don’t have any symptoms unless they develop a life-threatening infection. Even the bacteria in our mouth, gut or skin can cause an infection. That’s one of the reasons our blood counts are checked before receiving our chemo infusion. Infections may develop quickly and become a medical emergency.

Precautions to Take While You Are Neutropenic

Many precautions are common-sense:

• Avoid crowds, especially during flu season

• Don’t share personal items

• Use care disposing of pet waste

• Keep flu shots current

• Use soft toothbrush

• Wash your hands regularly

While there are no established standards for exactly what a neutropenic diet would consist of, there are several prudent eating recommendations.

No raw fruits or vegetables. Recent headlines about the current romaine lettuce recall due to e-Coli is a classic example of why cancer patients who have neutropenia should not eat raw fruits or raw vegetables (including salads). With a compromised immune system, you might experience a life-threatening or potentially fatal infection. Avoid the risk of fresh fruits and vegetables and err on the side of caution.

Cook meat and eggs thoroughly. Again err on the side of caution and avoid rare steaks or other undercooked meats. Avoid soft-boiled eggs and fried eggs with runny yolks. It’s only for a week or two until your white counts recover.

Avoid deli meat and cheese. Avoid the cut-to-order meats and cheeses in the grocery store due to the risk of cross-contamination or sloppy handling. It appears that the prepackaged sandwich meat and cheese are safe to consume.

Avoid yogurt and soft cheeses. It’s best to not consume yogurt, cheeses with a mold such as blue cheese and soft cheese like Brie.

Use this sample neutropenic diet to avoid the risk of infection from food consumption.


The most commonly used treatment is the Neulasta shot given 24 hours after your chemotherapy infusion. It boosts production of neutrophils so you’ll be ready for your next infusion.

Neutropenia – Treatment Options

The problem with neutropenia is that it can develop at any time in your treatment. Patients go in for next chemo and have developed neutropenia and must wait one or two weeks for their neutrophil count to rebound.

Patients resume their normal chemotherapy once their neutrophil count has rebounded. To help prevent neutropenia from developing again, most oncologists give their patient a Neulasta shot or use a Neulasta Onpro. You’ve probably seen the television ad for the Neulasta Onpro. The Onpro version is wonderful because it saves the patient another trip to their chemo center. Neulasta has to be given approximately 24 hours after chemo.

I experienced several episodes of neutropenia and got the Onpro at the end of my chemo. This on-body injector is about the size of an egg and sticks to your arm or upper abdomen. There is a timer, and it automatically injects the Neulasta over 45 minutes. It beeps when complete, and the patient pulls it off and disposes of it (according to the instructions). My chemo center was 42 miles away so this innovation saved me several hours of time and an 84-mile round trip on the day that I was most tired from my chemo.

One of the side effects of Neulasta is bone pain. Neulasta works by stimulating our bone marrow to produce more white cells including neutrophil cells. Take Claritin the day before you receive Neulasta and for four more days to help prevent the bone pain.

Neutropenia, ironically, seems to also signal a benefit. Becoming neutropenic is consistent with a patient’s chemotherapy being more effective. Studies show that patients who develop neutropenia have better survival than patients who don’t experience neutropenia.

Neupogen shots, given daily, before a patient’s next chemo can help prevent neutropenia.

The Bottom Line

Neutropenia has the potential for life-threatening infections. But with attention to simple infection control behavior like hand-washing, avoiding crowds and sick people and food safety, you’ll avoid the potential of a serious infection. While on strong chemo, pay attention to food recalls lessening your chances of a life-threatening infection.

Have you experienced neutropenia? Drop by WhatNext.com and share your experiences, your sharing may help countless others. Also please use the share buttons above or below this article and share with anyone going through chemo, it might just help them prevent going through it.

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