Bone marrow—the spongy material that fills the inside of the bones—produces red cells, white cells, and platelets. Chemotherapy drugs damage or destroy the cells inside the bone marrow and can dramatically lower the number of cells circulating in the blood. Frequent blood tests are crucial in determining whether your child needs transfusions. Many children treated for brain or spinal cord tumors require transfusions of red cells and sometimes platelets. When the number of infection-fighting white cells is low, your child is in danger of developing serious infections.

Absolute neutrophil count (ANC)

The activities of families of children with cancer revolve around the sick child’s white blood cell (WBC) count, and, specifically the absolute neutrophil count (ANC). The ANC provides an indication of the child’s ability to fight infection.

When a child has blood drawn for a complete blood count (CBC), one section of the lab report will state the total WBC count and a “differential.” This means each type of WBC will be listed as a percentage of the total. For example, if the total WBC count is 1500 mm³, the differential might appear as follows:

To calculate the ANC, add the percentages of segmented and band neutrophils, then multiply by the total WBC. Using the example above, the ANC is 49% + 1% = 50%; 50% of 1,500 (.50 x 1500) = 750; so the ANC is 750.

How to protect a child with a low ANC

Generally, an ANC of 500 to 1,000 provides children with enough protective neutrophils to fight off exposure to infection due to bacteria and viruses. With an ANC this high, you can usually allow your child to attend all normal functions such as school, athletic events, and parties. However, it is wise to keep close track of the pattern of the rise and fall of your child’s ANC. If you know the ANC is 1,000, but is on the way down, it will affect what activities are appropriate for your child. Each hospital has different guidelines concerning activities for children with low ANCs.

Following are parents’ suggestions for ways to prevent and detect infections:

Insist on frequent, lengthy (at least 1 to 2 minutes), and thorough hand washing for every member of the family. Use plenty of soap and warm water, lather well, and rub all portions of the hands, including between all the fingers and under the fingernails. Children and parents need to wash before preparing meals, before eating, after playing outdoors, and after using the bathroom.

• Make sure all medical personnel at the hospital or doctor’s office thoroughly wash their hands before touching your child.
• Keep your young child’s diaper area and skin creases clean and dry.
• Whenever your child needs a needle stick, make sure the technician cleans your child’s skin thoroughly with both betadine and alcohol.
• If your child gets a small cut, wash it with soap and water, rinse it with hydrogen peroxide, and cover it with a small bandage.
• When your child is ill, take his temperature every 2 to 3 hours. Call the doctor if your child’s temperature is 101^o F (38.5° C) or above.
• Do not permit anyone to take your child’s temperature rectally (in the anus) or use rectal suppositories, as these may cause anal tears and increase the risk of infection and bleeding.

• Do not use a humidifier, as the stagnant water can become a reservoir for contamination.
• Apply sunscreen whenever your child plays outdoors. The skin of children taking certain chemotherapy drugs or who have recently received cranial radiation therapy is sun sensitive, and a bad sunburn can easily become infected.
• Your child should not receive routine immunizations while on chemotherapy. Your child’s doctor or nurse can complete medical exemption forms for your child’s school.
• Siblings should not be vaccinated with the live polio virus (OPV); they should get the killed polio virus (IPV). Verify that your pediatrician is using the appropriate vaccine for the siblings.

• If your child’s ANC is low, an infected site may not become red or painful.

• Never give aspirin for fever, because aspirin and drugs containing aspirin interfere with blood clotting. Aspirin is not recommended for children in general. Ibuprofen may be given if approved by your child’s oncologist. If your child has a fever, call the doctor before giving any medication.
• Ask your child’s oncologist about using a stool softener if your child has problems with constipation. Stool softeners can help prevent anal tears.
• Call the doctor if any of the following symptoms appear: fever above 101° F (38.5° C), chills, cough, shortness of breath, sore throat, severe diarrhea, bloody urine or stool, and pain or burning while urinating. Bring your child immediately to the hospital if there is a fever and you know that your child is neutropenic (low ANC) because if not treated immediately, this could be a life-threatening situation.