There will be certain times during the course of your illness when you will be more susceptible to infections, particularly when your white blood cell count is at its lowest. This point is called the nadir . Infections are most likely when the nadir is down to 1,000 cells per cubic millimeter or less. You should do everything you can to avoid possible sources of infection at all times. But be especially vigilant when your susceptibility is greatest.
How Your Doctor Can Help It has become standard practice in many chemotherapy programs to raise white blood cell counts by giving colony-stimulating factors such as G-CSF (Neupogen) or GM-CSF (Leukine). These are synthetic forms of substances the body naturally secretes to stimulate bone marrow to produce white blood cells .
• CSFs are very effective and are used with chemotherapy to shorten the time when the white blood cell count is
extremely low. Raising the count decreases significantly the risk of serious infections.
• Much has been learned from the AIDS epidemic about giving antibiotics to people at risk before any infection
has developed. Prophylactic antibiotics have many benefits. Ciprofloxicin, for example, can decrease bacterial
infections when the white blood cell count is low.
• During the time when people receiving bone marrow transplants are profoundly immunosuppressed, the
prophylactic use of gancyclovir can prevent cytomegalovirus infections and oral Fluconazole can prevent
fungal infections.
• Getting a shot of influenza vaccine every autumn can help you avoid flu during an epidemic.
