What is neutropenia and how long does it last? What is a neutropenic diet?

What is neutropenia and how long does it last?

So neutropenia is when there is a type of white blood cells called neutrophils that are very low or absent in the blood. Neutrophils are very important in fighting bacteria and fungi, and the Melphalan kills the neutrophils or the cells that produce the neutrophils in the bone marrow. And until the new stem cells kick in, new neutrophils won't be made.

So typically, 4 to 5 days after the transplant, the neutrophil count will start going very low, usually under 500. That's when we worry about infections.

And typically it stays there for about 5 to 7 days before it starts recovering. So that period of time, people are more susceptible to bacterial infections in particular.

How is neutropenia related to transplant managed?

So eventually the low white blood cell count will recover on its own when the new stem cells are basically going to be making new white blood cells, that process takes anywhere from 7 to 14 days.

We can accelerate that process by giving a growth factor, the same growth factor we use to mobilize stem cells from the blood called G-CSF. We use that after the transplant at our center. We started around day seven when the stem cells have had a chance to expand a little bit and then we kick them into gear and usually within 3 to 4 days of giving those injections, white blood cell count recovery is hastened by those injections by 2 to 3 days on average.

What is a neutropenic diet?

Neutropenic diet is where you minimize the types of foods that maybe aren't cooked well that have bacteria on them.

So, for example, you know, moldy cheese, right? Blue cheese. That's not a good idea during a neutropenia because that can increase the risk for an infection. So things that are not washed well. So things that aren't cooked well like raw eggs, those things should be avoided during neutropenia. But there are a lot of controversies in this area that we do understand now that within our gut there is a large microbiome.

And some studies suggest that following strict neutropenic diets make absolutely no difference in how patients get through transplant. So normally what I tell patients is eat a healthy diet, avoid certain foods that increase your risk as long as food is cooked is generally good.

Most of the time during the transplant procedure, I tell them to eat chicken noodle soup because it's like getting through a flu that works really well and it's light on the stomach.

So that's usually what I recommend.

So we're actually looking to change our practice when it comes to the neutropenic diet, there was a very nice trial that was just presented at this year's Ash meeting where they actually randomized patients to the neutropenic diet versus a routine normal diet that was sensible and they found no differences in terms of the infectious rates and patients satisfaction was much higher.

We asked patients to be sensible, so we asked them to cook food properly, to not consume raw or undercooked products, the same as, you know, sensible practice for any patient whose immunosuppressed we ask them to wash things carefully, peel things that need to be peeled. But, other than that, I think it's important for patients to eat what feels good for them as long as it sensible has a high nutritional value, isn't too high and empty calories.

Those are the kind of things that we ask patients to steer towards and then to steer away from things that could potentially bear food borne pathogens and be risk to them in terms of food poisoning.

I know that at our institution, we generally put limits on, some of the very high protein probiotic containing, yogurts and some of the fermented, drinks that people might be interested in. We don't put specific regulations on fresh produce that people might, might want to want to eat. Some places do provide quite strict limits.

Still about not eating fresh fruits and vegetables that you can't peel or that you can't really clean very thoroughly. I think the big examples like strawberries or raspberries or other delicate fruits like that, where you have a lot of nooks and crannies that you really can't, can't get into. And so the best advice I have is to just talk to your health care team and find out what their what their regulations and their thoughts are.