# Almost zero WBC count

1. Had a patient this weekend...breast CA...who was on my floor (renal) only because our oncology unit was full. Her WBC was 0.5, she was put on reverse isolation. A float nurse who had her on the day shift said that when she goes to the onclology unit to work no patient are on isolation. What is your floor's procedure for an almost zero WBC count?

Joined: Jul '01; Posts: 963; Likes: 25
RN-Renal unit

3. We calculate the pt's ANC (absolute neutrophil count)=(%bands + %segs) x WBC's. If <1000 = neutropenic precautions (reverse isolation), and if they are <500 = severely neutropenic.
You calculate this formula using the WBC and differential lab value for the pt.
4. Then that float nurse may not be paying attention to what is going on. People with lwo white counts are always put on reverse precautions. Go with what you know.
5. Hey, Thanks guys. And I really doubted what she said, but just wondering what you do.
6. On my oncology floor, neutopenic patient are not placed on isolation. They are usually placed in private rooms but if one is not available then they are place in any room available on the floor. Even BMT patients are not placed on isoloation when their counts are zero.
7. Misty_z

As a hem-onc and BMT nurse - I am an expert on neutropenia

You are absolutely correct - ALL neutropenic patients should be on neutropenic precautions which is exactly the same thing as reverse isolation. It's simply protecting the patient.

Things are getting looser though. We are actually starting to let some of our leukemia inductions go home after treatment. (White counts stay <0.1 for about 21-28 days) The research is showing that most infections come from within the patient - gut flora, pre-existing infection, etc. No amount of isolation is going to protect you from that.

My theory has always been that I do not want to wonder if I caused harm. I am catholic and have enough guilt

good job in looking out for the patients interests!!
8. They have found that the patients who are not in isolation tend to recover better when neutropenic. At least that is what we do on our floor. I guess every hospital has different policies
9. You know, it's funny that we worry so much about the neutropenic patient that dares to cross our thresh hold !!
Yet, we tend to forget that, with MOST of the chemo and it's related neutropenia is done as an outpatient.
I would wager that we only see 5% of the oncology patients.
We do alot of BMTs as TOTAL outpatients !!! And our leukemics used to stay for 6 weeks...we're down to 3-4 weeks with a few going home right after chemo is done !! WOW!!
One guy is in college and doesn't miss much school....although sometimes he does it online...I'm still trying to get him to do MY homework but he wants top billing !! DO YOU BELIEVE IT!!
We teach them how to deal with it. Handwashing, Handwashing, Handwashing !!!!
Avoid crowds, if you want to go out to dinner or go to the movies or go shopping, go in the off times. Don't go into heavy crowds. If you must, then wear a mask. No gardening when neutropenic (fertalizer is after all....poop
Our patients are successful most of the time.
When they are admitted and severly neutropenic we try to place them in a private room or with someone not infected (like a DVT)
What an interesting speciality...I love it !!
Kat
10. Kat.

We also do bmt's as outpatient as well it all depends on how the patients respond. Every Patient is different. We do the same thing on our floor as well.
11. When I started in Oncology 17 years ago (LPN then RN) we used strict Neutropenic Precautions. Things have really relaxed in the past 10 years. Now we post the precautions but the door is open, we don't mask the patients in hallways...we still do not allow plants/flowers or fresh veggies/fruit. In the office setting, we teach the precautios but encourage our patients to go out at low traffic time to stores, restaurants...
12. I work on the haematology ward of a relatively large cancer hospital. More than half of our patients have a lower than normal blood count, and if someone is really low (nearly or = 0.0 neutrophils) we tend to watch them carefully and do lots of checks (e.g. test urine, sputum, blood, etc daily).
We tend not to isolate someone unless an infection is suspected, as it can be very demoralising to the patient.

All visitors, staff etc. have to wash hands before entering the ward, however, and hygiene is high priority. No flowers, etc., and no colds (unless the patient is in the terminal phase - special situation, of course.) I think we reach a good compromise!
13. Hey all,

I'm a student and don't know a lot but just one quick question, it sounds like a lot of your oncology patients are neutropenic. Is this because of the <i>chemotherapy</i> usually or are there other things going on?

Z
14. Good question!! Actually it can be from both. Chemotherapy will kill off the "bad" cancer cells but while it is at it, will kill off some of the good cells resulting in neutropenia. On the other hand, people with blood dyscrasias such as acute leukemia, have veins full of immature cells that can't fight anything. Thats why you may hear of someone finding out that they have Leukemia because of a tooth abcess or other infection. Or they have bruises because they have so few platelets (the little sticky things in the blood that help with clotting and until the body is able to produce them, do not live long----only a few days)
What a great field....I love oncology........
Good luck to you !!
Kat