Neutropenia and Nutrition

  1. I am an LPN and have been in corrections and pediatrics for several years. Even when I was in school and clinical rotations, our studies in Ocology were extremely limited.

    Here is my query ... Our mom is receiving Herceptin treatments along with Carboplatin and Taxotere for HER2+ Stage 3 breast cancer. Her WBC's have dropped below 5,000 on 2 occasions, causing them to skip her weekly treatments. Being in a small town, our medical libraries are very limited and the MD and nurses are not so helpful in providing ideas on how to help maintain her counts. It has also been told she is not a candidate for Neupogen injections.

    We were given a list of foods that she can eat and that was it. Any other suggestions? Or ideas on where I can find more research on this subject?

    Thank you so much for all you do!!!

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  3. by   onc nurse
    You could research "neutropenic diet" to give you exact details to follow. When she is neutropenic with an ANC < 1.0, she should follow the diet. Mainly stay away from anything fresh...i.e. fresh fruit, veggies, lettuce, unprocessed cheeses, etc. (anything that could carry bacteria). Canned fruit and veggies should be OK. Also, thick skinned fruits are OK, but generally having someone else peel the banana for the patient is the safest bet. Though there is conflicting research as to whether the neutropenic diet is necessary, we teach it to our inpatients. If she experiencing nausea, stay away from spicy foods or hot foods.
  4. by   KMRNOCN
    I'm a bit confused. Why doesn't she qualify for Neupogen or Neulasta support? I'm sorry to say, it could be an insurance payment issue. I see your post was a few weeks ago so she's either had treatment delays or they've given her the growth factor support. If it is an insurance issue many insurances will pay for Neupogen or such agents as home injection. We have had to explore that option with some insurance payers in our area. And sadly, there is nothing you can eat to build up your WBC counts. The previous reply provides excellent information on precautions with low white cell counts.
  5. by   Alloush

    wait a little bit. a WBC of 5000 or 4000 or 3000 or 2000 or even 1000 is perfect for a cancer patient on chemotherapy. and she doesnt need any neupogen support when her count is like that. we usually start neupogen for Neutropenic patients which means WBC < 300 for at least 2 weeks. ANC = 0 for at least 2 weeks. patient is ill ( febrile and on IV antibiotics ). if the condition is stable then no need for any support.

    they were skiping her weekly doses becoz of the protocol rquirements maybe but not becoz she is neutropenic... she is not neutropenic with such counts.

    + she can eat anything she likes as long as her counts are WBC > 500 ANC > 800

    i hope she will get better soon
  6. by   rn undisclosed name
    We have recently redone our ntp diet protocol. Now we are telling our patients no fresh berries and no fresh broccoli. It is not as restrictive as it once was. I'd probably stay away from sushi too.

    I agree those counts are not considered neutropenic. We don't start instituting ntp precautions unless there counts are less than 2,000 and then it depends on the ANC more so than the WBC.

    I have talked to several people about the neutropenic diet and there appears to not be any evidence based practice regarding the use of it. I haven't researched it myself.

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