Neutropenia and Avoiding Infection in Patients With Acute Myeloid Leukemia

Patients with acute myeloid leukemia (AML) are extremely susceptible to infection, especially due to the prevalence of neutropenia. This condition is the primary risk factor of infection for this patient population, Yoav Golan, MD, MS, FIDSA, attending physician and associate professor of medicine at Tufts University School of Medicine, told MD Magazine as part of a recent Peer Exchange.

Neutropenia is typically defined as an absolute neutrophil count (ANC) count of less than 1500; real neutropenia is less than 1000; and severe neutropenia is less than 500. Patients with a count of lower than 100 are considered to be at the highest risk of infection.

There are several contributing causes to the high rate of neutropenia within AML patients.

“One of the causes of neutropenia is, in fact, the disease itself,” Dr Golan explained. “The expansion of one clone of white cells will prevent other white cells from flourishing and the diversity of those neutrophils—not necessarily their number—would be reduced. The expansion of this clone in the bone marrow will prevent the production of new neutrophils and will result in neutropenia as well.”

Other factors involve AML treatments which target the immune system and exacerbate a patient’s immunocompromised state. Additionally, chemotherapy treatments further deplete the number of neutrophils and are the main reason for neutropenia during AML therapy.

Besides neutropenia and a weakened immune system, patients may also contract infections from minor exposures such as raw foods, well water, and interactions with some pets—for example, patients should avoid cleaning cat litter. Other high risk exposures come from increased time in the healthcare system where procedures and lines interrupt mucosal surfaces.

Preventive measures include avoiding unnecessary risks, patient vaccinations and vaccinations for those in consistent contact with the patient, infection control actions such as thorough hand hygiene or wearing masks during intense treatment periods, and antimicrobial prophylaxis.