Pseudoneutropenia as a factor-limiting access to chemotherapy for cancer patients: the effect of a simple meal
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ORIGINAL ARTICLE
Pseudoneutropenia as a factor-limiting access to chemotherapy for cancer patients: the effect of a simple meal Anna Waszczuk-Gajda 1 & Leszek Kraj 1 & Krzysztof Woźniak 1 & Ewa Żurawińska-Grzelka 1 & Ruth Hutch 2,3 & Grzegorz Władysław Basak 1 & Wieslaw Wiktor Jedrzejczak 1 Received: 29 July 2020 / Accepted: 16 November 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Background Absolute neutrophil count (ANC) below 1.5 g/l or 1 g/l is commonly used as a factor to determine the decision to administer antineoplastic treatment including chemotherapy and novel agents to cancer patients. This practice is based on observations that below this ANC, there is an increased risk of bacterial and fungal infection. This is further based on the assumption that this parameter always correctly reflects the true shortage of these germ-fighting cells in patients. In reality, the circulating pool of neutrophils is only one of four reservoirs (bone marrow, circulating, marginal and tissue pools) and its size is influenced not only by shortage but also by transient shift of cells between these reservoirs. The aim of this study was to evaluate whether repeated blood collection affects ANC in the patient. Methods We retrospectively analysed the medical records of cancer patients with 0.8 g/l ≤ ANC < 1.5 g/l in whom CBC was repeated based on the physician’s decision, which was done on the same day roughly 2 h after the first one. Results The patients at the time of repeating CBC had consumed breakfast. In 31 out of 32 patients, ANC exceeded 1 g/l or 1.5 g/l and antineoplastic treatment was administered as originally planned. There were no infectious complications observed. Conclusion Cancer patients should not be fasting prior to blood collection, with the exception of special and rare situations. To achieve the maximum clinical benefit, delays and/or reductions of antineoplastic treatment should be avoided wherever possible. Pseudoneutropenia is an unnecessary reason for postponing chemotherapy. Keywords Neutropenia . Pseudoneutropenia . Antineoplastic treatment . Hydrocortisone test . Prednisone test
Introduction Neutropenia less than 1.5 g/l or less than 1 g/l is commonly used as a pivotal determining factor in the decision to administer antineoplastic treatment including chemotherapy
and novel agents (i.e., small molecular kinase inhibitors or other targeted therapy drugs) to cancer patients. This practice is based on observations by Bodey et al., who found that below this neutrophil level, there is an increased risk of life-threatening bacterial and fungal infections [1]. This is
* Anna Waszczuk-Gajda [email protected]; [email protected] Leszek Kraj [email protected]
Grzegorz Władysław Basak [email protected] Wieslaw Wiktor Jedrzejczak [email protected] 1
Department of Hematology, Oncology and Internal Medicine, Medical University of Warsaw, 1a Banacha Str, 02-097 Warsaw, Poland
2
Deparment of Hematology, Oncology and Internal Medicin
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