Precautions with Neutropenic Patients

Before our daughter was diagnosed with severe neutropenia about a month ago, I had never even heard of neutropenia before, so I had no idea how to take care of a neutropenic patient until I did some research of my own. Upon her first blood test, her neutrophils were at zero, which is a medical emergency, and her chest x-ray showed she had pneumonia. Our pediatrician was very concerned about her because having a neutrophil count of absolute zero is very serious and the risk of sepsis setting in is high. The incidence of mortality and the time antibiotics are first administered are directly related. This is why, when we first got to the hospital, I was adamant that antibiotics be started asap. Unfortunately, 2 days after the IV antibiotics had been started, she had an allergic reaction to the antibiotic, and the antibiotics had to be stopped. Having an allergy to the antibiotics means that we need to be extra cautious while our daughter is neutropenic because if she develops an infection, the antibiotics she can take are very limited and not as effective in neutropenic patients or as safe in children.

(Currently, our daughter is still neutropenic, but she is improving slowly. This is a very good sign that this was caused by a sinister virus and that she will eventually make a full recovery; it just might take some time.)

For those of you who want to know more about neutropenia, here is a good overview of what it is. You can find more information about neutropenia here, too. I have put together my own little list about precautions to take with a neutropenic person. My husband and I have done lots of research about neutropenia, so this list is just a compilation of precautions I can think of off the top of my head from information I've gathered over these past few weeks.

• Neutropenic patients need to be in strict isolation. (No contact with people displaying any signs of illness, including coughing, sneezing, sniffling. Medical professionals should wear gloves and a mask when caring for a neutropenic patient.)
• Avoid crowds and public places. (We have chosen to have only immediate family visit our daughter for now and only if they have no symptoms of sickness.)
• Avoid contact with anyone who has received a live vaccine in the past 30 days (6 weeks for chicken pox vaccine)
• Our pediatrician recommended that our daughter not get any vaccines for at least another 8-12 weeks.
  
• Frequent handwashing and good hygiene is very important for preventing the spread of infections
  
• Rectal thermometers should not be used in neutropenic patients
• Avoid fresh fruits and vegetables, salad bars, buffets, uncooked grains, yogurt, foods with active bacterial cultures in it, unpasteurized foods, undercooked eggs and meats, and breads baked with active yeast. Water must be either distilled or boiled for 10 minutes and then cooled. Note: Most baby cereals these days contain active bacterial cultures. Check the labels carefully and only feed your child those that do not have active cultures. This is something we only found out recently, and unfortunately, we had been feeding her yogurt (her favourite food) and cereal with active bacterial cultures in it until we found this out by our own research.
  
• Have visitors take their shoes off before coming in the house
• Avoid contact with pets
• Watch patient closely for fever. A fever in a neutropenic patient needs to be investigated immediately.
  

This is not meant to be taken as medical advice. Please consult a medical professional for advice on treating a person with neutropenia.