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NCCN Guidelines for Patients Anemia and Neutropenia NCCN GUIDELINES FOR PATIENTS® 2021 Anemia and Neutropenia Low Red and White Blood Cell Counts NATIONAL COMPREHENSIVE CANCER NETWORK Presented with support from: FOUNDATION Guiding Treatment. Changing Lives. Available online at NCCN.org/patients Ü Anemia and Neutropenia It's easy to get lost in the cancer world Let Ü NCCN Guidelines for Patients® be your guide 9 Step-by-step guides to the cancer care options likely to have the best results 9 Based on treatment guidelines used by health care providers worldwide 9 Designed to help you discuss cancer treatment with your doctors NCCN Guidelines for Patients®: Anemia and Neutropenia, 2021 1 About NCCN Guidelines for Patients® are developed by the National Comprehensive Cancer Network® (NCCN®) NCCN Clinical Practice NCCN Guidelines NCCN Ü Ü Guidelines in Oncology for Patients (NCCN Guidelines®) 9 Developed by doctors from 9 Present information from the 9 An alliance of leading NCCN cancer centers using NCCN Guidelines in an easy- cancer centers across the the latest research and years to-learn format United States devoted to of experience patient care, research, and 9 For people with cancer and education 9 For providers of cancer care those who support them all over the world Explain the cancer care Cancer centers 9 options likely to have the that are part of NCCN: 9 Expert recommendations for best results NCCN.org/cancercenters cancer screening, diagnosis, and treatment Free online at Free online at NCCN.org/patientguidelines NCCN.org/guidelines and supported by funding from NCCN Foundation® These NCCN Guidelines for Patients are based on the NCCN Guidelines® for Hematopoietic Growth Factors Version 2.2021 – March 23, 2021. © 2021 National Comprehensive Cancer Network, Inc. All rights reserved. NCCN Foundation seeks to support the millions of patients and their families NCCN Guidelines for Patients and illustrations herein may not be reproduced in affected by a cancer diagnosis by funding and distributing NCCN Guidelines for any form for any purpose without the express written permission of NCCN. No Patients. NCCN Foundation is also committed to advancing cancer treatment one, including doctors or patients, may use the NCCN Guidelines for Patients for by funding the nation’s promising doctors at the center of innovation in cancer any commercial purpose and may not claim, represent, or imply that the NCCN research. For more details and the full library of patient and caregiver resources, Guidelines for Patients that have been modified in any manner are derived visit NCCN.org/patients. from, based on, related to, or arise out of the NCCN Guidelines for Patients. The NCCN Guidelines are a work in progress that may be redefined as often National Comprehensive Cancer Network (NCCN) / NCCN Foundation as new significant data become available. NCCN makes no warranties of any 3025 Chemical Road, Suite 100 kind whatsoever regarding its content, use, or application and disclaims any Plymouth Meeting, PA 19462 responsibility for its application or use in any way. 215.690.0300 NCCN Guidelines for Patients®: Anemia and Neutropenia, 2021 2 Supporters Endorsed by The Leukemia & Lymphoma Society The Leukemia & Lymphoma Society (LLS) is dedicated to developing better outcomes for blood cancer patients and their families through research, education, support and advocacy and is happy to have this comprehensive resource available to patients. LLS.org/patientsupport To make a gift or learn more, please visit NCCNFoundation.org/donate or e-mail [email protected]. NCCN Guidelines for Patients®: Anemia and Neutropenia, 2021 3 NCCN Guidelines for Patients®: Anemia and Neutropenia, 2021 4 Anemia and Neutropenia Contents 6 Blood 15 Testing 24 Anemia 31 Neutropenia 34 Febrile neutropenia 41 Thrombocytopenia 46 Myeloid growth factors 50 Making treatment decisions 58 Words to know 60 NCCN Contributors 61 NCCN Cancer Centers 62 Index NCCN Guidelines for Patients®: Anemia and Neutropenia, 2021 5 1 Blood 7 Blood basics 8 Blood cell types 10 How blood is made 11 Anemia 12 Neutropenia 12 Thrombocytopenia 13 Acute lymphoblastic leukemia 13 Acute myeloid leukemia 13 Myelodysplastic syndromes 14 Review NCCN Guidelines for Patients®: Anemia and Neutropenia, 2021 6 1 Blood Blood basics Blood is a body fluid made up of 4 Blood cells have important jobs. Red blood factors: plasma, red blood cells, white cells carry oxygen throughout the body. White blood cells, and platelets. Blood has blood cells fight infection. Platelets help control many functions, including carrying bleeding. Plasma transports red blood cells, oxygen and nutrients. This chapter white blood cells, and platelets. provides a look at the various blood cell types and their functions. Blood cells don’t live forever. Normal red blood cells live for 3 months. Normal white blood cells live for 8 to 14 days. Normal platelets live for about a week (7 days). After cells reach these ages, they die off and are replaced by Blood basics new cells. Your blood cells are being replaced in your body all the time. Blood is made up of plasma and cells that float within it. Plasma is the liquid part of the Blood has many functions. These include: blood, comprised mostly of water. Plasma also contains proteins, hormones, vitamins, and Transport - Blood takes oxygen from minerals. Blood takes oxygen and nutrients to the lungs to the cells of the body. It takes your body’s tissues, and carries away wastes. carbon dioxide from the body’s cells to the lungs where it is breathed out. Blood also carries nutrients, hormones, and waste products around the body. Blood stem cells Bone marrow contains stem cells. A blood stem cell is an immature cell that can develop into a red blood cell, a white blood cell, or a platelet. NCCN Guidelines for Patients®: Anemia and Neutropenia, 2021 7 1 Blood Blood cell types Regulate - Blood helps to keep the check on the size, number, shape, and health acid-alkali balance of the body in check. of your red blood cells. It also plays a part in regulating body temperature. Increasing the amount of If red blood cells are damaged, they are no blood flowing close to the skin helps the longer able to carry oxygen and can release body to lose heat. toxins. This may lead to kidney damage. Problems with red blood cells may be caused Protect - White blood cells attack and by illness or a lack of iron or vitamins in your destroy invading germs (bacteria) and diet. Some diseases of the red blood cells are other pathogens. Blood clots form after an inherited (passed down from one’s parents injury, which protects the body from losing or ancestors). Diseases of the red blood cells too much blood. include many types of anemia. Anemia is a condition where your body does not make enough healthy red blood cells, resulting in Blood cell types less oxygen in your cells. There are 3 types of blood cells: White blood cells White blood cells (WBCs) are essential to the Red blood cells (erythrocytes) immune system by helping to fight infections. For example, if a microorganism (bacteria White blood cells (leukocytes) or virus) enters the blood, through a cut or Platelets an infection, white blood cells surround and destroy the invading cells. Red blood cells There are several types of white blood cells: Red blood cells (RBCs) look like tiny flat doughnuts without holes. They get their color Monocytes from hemoglobin, an iron-containing protein that picks up oxygen in the lungs. As the Lymphocytes blood travels throughout the body, hemoglobin Neutrophils releases oxygen to different body parts. Then, red blood cells pick up carbon dioxide from Basophils tissues and organs and carry it back into the Eosinophils lungs for removal. Monocytes Red blood cells live for about 120 days. Each Monocytes are the largest type of white blood day, the body makes new red blood cells. They cells. They have a longer lifespan than other are made inside part of the bone called bone white blood cells. Monocytes help to break marrow. Bone marrow produces 7.5 billion down bacteria and clean up dead cells. red blood cells every hour, or 2 million each second. Your doctor will use a blood test to NCCN Guidelines for Patients®: Anemia and Neutropenia, 2021 8 1 Blood Blood cell types Lymphocytes Eosinophils Lymphocytes are a form of white blood cell. All Eosinophils attack and kill bacteria and lymphocytes fight bacteria, viruses, and other parasites (such as worms), and help with potentially harmful invaders. However, some allergic responses. These cells are best known white blood cells have specific jobs. for their role in creating allergy symptoms when fighting off invaders (such as pollen). There are 3 types of lymphocytes: Platelets B lymphocytes (B cells) make antibodies Platelets (thrombocytes) are tiny, plate-shaped to help the body fight infections. cells that form clots. Platelets circulate in the T lymphocytes (T cells) attack foreign blood. When a damaged blood vessel is found, cells, cancer cells, and virus-infected they bind together to create a clot. Platelets cells. work with proteins called clotting factors to control bleeding inside your body and on your Natural killer cells (NK cells) kill virus- skin. Platelets only survive about 9 days in infected cells or tumor cells. These cells the bloodstream. They are constantly being are different in that they can “remember” replaced by new platelets made in the bone certain virus cells for many years and marrow. fight to keep the body from being infected again. Plasma Neutrophils Plasma is a straw-colored liquid that makes up Neutrophils kill and digest bacteria and fungi. more than half (60%) of the blood’s volume. They are the most numerous type of white Plasma contains water, salts, enzymes, blood cell, making up nearly half of all white antibodies, and other proteins.
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  • Neutropenia Fact Sheet
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