The Health | november, 2019
14
Column
The terrible, terrible
Neutropenic Sepsis
When you don’t have enough firepower to fight off infections after chemotherapy
O
ur blood is composed of different
types of cells, namely: red cells,
white cells and platelets. And
what exists among the white cells
are various ‘soldiers’ assisting the
immune system of the body. They
are neutrophils, lymphocytes, monocytes,
eosinophils and basophils.
The neutrophils
The neutrophils normally constitute about
60-70 per cent of the total white cell count.
They circulate in the blood and are found
inactive in our bone marrow. The neutrophils
take approximately six days to enter the blood
circulation from the bone marrow, and they
have a circulating life span of between eight
hours to five days. Within the blood, neutro-
phils respond early to signals reporting injury
or infection, and migrate to the affected area.
They have a role in both directly killing cells
that are foreign to the body such as bacteria
by phagocytosis (engulfment of cells) and
chemical damage, and they can also activate
other types of white cells to also take part in
the immune process.
How chemotherapy can badly
affect our immune system
In patients who are diagnosed with cancer, the
treatment offered is usually chemotherapy
with or without radiotherapy, depending on
the type of cancer. The treatment is designed
to kill cancer cells by damaging the DNA
sepsis
alert
By Dr Azlin Ithnin
&
Dr Tan
Toh Leong
beyond repair.
The mechanism behind this damage differs
based on the type of chemotherapy used.
The more rapidly dividing normal tis-
sues such as hair follicles, mucosal linings
and bone marrow cells can also be affected,
which explains why patients can get hair loss,
inflammation of the mucosal tissue and sup-
pression of the bone marrow when receiving
chemotherapy.
When the bone marrow is suppressed, it
leads to low white cell counts and specifically
low neutrophil counts (neutropenia), low red
cell counts (anaemia) and low platelet counts
(thrombocytopenia).
For the majority of chemotherapy regi-
mens, the neutrophil count falls to its lowest
level approximately five to seven days after
administration of chemotherapy and can
take up to two to four weeks to recover. The
time may defer depending on different types
chemotherapy given.
Lack of neutrophils lead to sepsis
When one is neutropenic, there are not
enough neutrophils to help protect the body
from invasive infection and this may cause
overwhelming sepsis and death. This is spe-
cifically called neutropenic sepsis.
When this occurs, the body does not try to
only attack the germs invading the system,
the body’s response also injures our own tis-
sues and organs. Deterioration can be very
rapid, sometimes without an obvious focus
Creating
health-promoting
environment
T
Health-promoting environments
reduce risk factors
According to the World Health Organisation
(WHO), governments must take the lead to
expand health-promoting environments within
the nation to reduce diabetes risk factors.
It should promote regular physical activity,
rejecting unhealthy diets, and strengthening
national capacities to help people with diabetes
receive the treatment and care they need to
manage the condition.
According to former WHO Director-General
Dr Margaret Chan: “If we are to make any
headway in halting the rise in diabetes, we need
to rethink our daily lives: to eat healthily, be
physically active, and avoid excessive weight
gain.
Even in the poorest settings, govern-
ments must ensure that people are able to
make these healthy choices and that health
Not all will have it
However, not all patients undergoing che-
motherapy will develop neutropenic sepsis.
The risk varies greatly according to the
treatment regimen and whether supportive
treatment has been given together with the
chemotherapy.
Other risk factors for neutropenic sepsis
can include elderly patients, patients who
depend on others for their basic needs, poor
nutritional status, underlying blood cancers
and intensity of chemotherapy.
Neutropenic sepsis is a medical emergency
that requires immediate hospital investiga-
tion and further treatment.
As the mortality rate associated to neutro-
penic sepsis is high, any patients undergoing
chemotherapy which have a neutrophil count
of less than 0.5 x109/L associated with a high
temperature of more than 38°C (even one
reading) will be immediately treated with
antibiotics.
Hence it is important for the patient
and family members to be aware when the
patient is feeling unwell and have a spike of
fever to bring the patient immediately to the
hospital without waiting for other symptoms
to appear. — The Health
Dr Azlin Ithnin is the Vice President of Malay-
sian Sepsis Alliance and a Senior Lecturer and
Chemical Pathologist Consultant, UKM Medical
Center, Universiti Kebangsaan Malaysia
Assoc Prof Dr Tan Toh Leong is thePresident
and Founder of Malaysian Sepsis Alliance and
a Senior Lecturer and Emergency Medical
Consultant, UKM Medical Center, Universiti
Kebangsaan Malaysia
A healthy meal
doesn’t have to be
boring and bland.
The most important
thing is to have
balance.
We need to rethink our lives: Eat healthy, be
physically active, and avoid excessive weight gain
he number of people living with
diabetes has almost quadrupled since
1980, about 422 million adults with
most living in developing countries.
Factors driving this dramatic rise
include being overweight or obese.
for infection.
If left untreated, death due to neutropenic
sepsis has been reported to be between two to
21 per cent. There is a tendency for neutrope-
nic sepsis to occur more commonly in the first
two cycles of treatment. Also, blood cancers
are noted to be the most common type of
cancer associated with neutropenic sepsis.
systems are able to diagnose and treat people
with diabetes.”
WHO report on diabetes
In its first ‘Global Report on Diabetes’, WHO
highlights the need to step up prevention and
treatment of the disease.
Among the key findings of the report are:
Many of the diabetes deaths (43 per cent)
occur prematurely, before the age of 70, and are
largely preventable through adoption of policies
to create supportive environments for healthy
lifestyles and better detection and treatment
of the disease.
Good management includes use of small set
of generic medicines; interventions to promote
healthy lifestyles; patient education to facilitate
self-care; and regular screening for early detec-
tion and treatment of complications.
The findings clearly tell us that many cases of
diabetes can be prevented, and measures exist
to detect and manage the condition, improving
the odds that people with diabetes live long and
healthy lives.
As a community and individuals, we need
to do more to combat diabetes, but where do
we start?
Community-driven effort
Firstly, we need to create an environment that
supports healthy lifestyle that makes a positive
impact on the well-being of the community, as
in to promote fun physical activities.
Secondly, it is our joint responsibility and
moral obligation to promote environments that
ensure healthy choices are available wherever
we spend our time. And thirdly, we need to
develop a set of conscience that provide as well
as seek out healthy food and drinks.
Let’s place good health at the centre of
our everyday lives by helping create health-
promoting environments in places such as
schools, workplaces, healthcare centres, food
outlets, parks, and in our own homes.
We are changing us
Making healthy choices is not just about having
good self-discipline. It is about having someone
to support you whenever you lose strength in
becoming healthier.
And although self-motivation does play a big
part in our road towards better health, to have
that extra external support means the world.
The most supportive of environment makes
healthy choices that much easier. — The Health