Low Blood Counts and Fever — During Chemotherapy
When chemotherapy lowers your white blood cell count, a fever stops being an ordinary symptom. It becomes an emergency. This page explains why counts fall, which sign to never wait on, and what you can do to reduce your risk.
Medically reviewed by Dr. T. Raghavender Reddy, Medical Oncologist, MBBS · DM (Medical Oncology) · MD (Radiation Oncology) · Last reviewed September 2026
- Fever is not ordinary here — A temperature during chemotherapy is a medical emergency until your team has ruled out a serious infection.
- Risk peaks mid-cycle — Blood counts usually reach their lowest point around seven to fourteen days after each dose — the highest-risk period of your cycle.
- Speed is what saves — Neutropenic fever can become life-threatening within hours. The time between fever and treatment is what determines the outcome.
- You can reduce your risk — Hand hygiene, food precautions, and knowing which symptoms to report cut your chance of a serious infection during treatment.
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Chemotherapy damages the bone marrow cells that make infection-fighting white blood cells. When those cells fall to very low levels — a condition called neutropenia — even a mild infection can become life-threatening within hours. A fever during chemotherapy is a medical emergency until proven otherwise. Call your team immediately or go to hospital now.
Why does chemotherapy lower your blood counts?
Chemotherapy targets fast-dividing cells. Cancer cells divide quickly, but so do the cells in your bone marrow that make blood. When chemotherapy reduces bone marrow activity, it reduces the production of all three blood cell types: red cells, white cells, and platelets.
The most critical effect for infection risk is the fall in neutrophils — white blood cells that are your body's first defence against bacteria. When neutrophil levels fall very low, your body has almost no ability to fight a bacterial infection on its own.
Counts usually reach their lowest point — called the nadir — around seven to fourteen days after a chemotherapy dose, though this depends on the specific drugs you are receiving. Your team will tell you which days carry the highest risk for you.
Terms you will hear from your team
- Neutrophils
- White blood cells that are your body's first line of defence against bacterial infection. They are the cells most reduced by chemotherapy.
- Neutropenia
- A fall in your neutrophil count to a level where infection risk becomes significant. Most people on chemotherapy experience a period of neutropenia after each cycle.
- ANC (absolute neutrophil count)
- The specific blood test number your team uses to measure your neutrophil level. It is part of your routine blood count and tells your team how protected you are against infection at any point in your cycle.
- Nadir
- The lowest point your blood counts reach after a chemotherapy dose. It is the highest-risk period of your cycle and usually falls in the second week after treatment.
- Neutropenic fever
- A fever when your neutrophil count is already very low. This combination — fever plus neutropenia — is an oncological emergency. It is also called febrile neutropenia.
- G-CSF
- A class of growth factor injections your team may prescribe to help your bone marrow recover and produce neutrophils faster. Not everyone receives them. Your team will tell you if they are part of your treatment plan.
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What temperature is an emergency during chemotherapy?
NCCN and ASCO define neutropenic fever as a temperature of 38°C or above in a person with a very low white cell count. Any reading at or above that level during chemotherapy is an emergency — not a symptom to monitor overnight.
Do not take paracetamol first to see if the fever settles. Paracetamol will bring your temperature down and mask the emergency. Your team cannot assess how serious your infection is if your temperature has been artificially lowered before you arrive.
If you cannot reach your oncology team immediately, go to the nearest emergency department and tell them you are on chemotherapy. Use the words neutropenic fever. Time to treatment determines the outcome, and waiting for a callback is not safe.
What reduces your infection risk during chemotherapy?
Wash your hands — and remind everyone around you to do the same
Hand washing is the single most effective way to prevent infection during chemotherapy. Wash your hands before eating, after using the toilet, after being in any public space, and whenever you have touched a surface others have handled. Alcohol-based sanitiser works well when a sink is not available. Ask any visitor to wash their hands before touching you or anything in your room — this is not an unusual request during chemotherapy.
Be careful with food and water
When your blood count is low, some foods carry a higher risk of bacterial contamination. Avoid raw or undercooked meat, fish, and eggs. Choose freshly cooked food rather than food that has been standing for hours or reheated multiple times. Wash all fruit and vegetables carefully before eating. If you are unsure about tap water quality, drink boiled or sealed bottled water. Ask your oncology team or a dietitian which specific precautions apply to your treatment and your situation.
Avoid crowds and anyone who is unwell
When your neutrophil count is low, your body cannot fight infections the way it normally would. Crowded indoor spaces — busy markets, public transport, waiting rooms — increase your exposure to bacteria and viruses. Ask any family member or visitor who has a cough, cold, stomach upset, or any active illness to stay away until they have fully recovered. This is not an overreaction. It is what the evidence supports during the high-risk period of your cycle.
Keep your mouth clean
Chemotherapy can cause mouth sores and gum inflammation, which create small breaks in the lining of your mouth that bacteria can enter through. Rinse your mouth gently after every meal using the solution your team recommends. Use a soft toothbrush and brush carefully twice a day. Tell your team about any mouth sores, white patches, or mouth pain — these can be signs of infection that need treatment. Do not use any mouth rinse or oral gel without asking your team first.
Care for your skin and any lines or catheters
Your skin is a barrier against infection, and any break in it is a potential entry point for bacteria. This includes scratches, pressure sores, and the site of any central line or PICC line. Keep the area around any catheter or line clean and dry according to your team's specific instructions. Report any redness, swelling, warmth, or discharge around a line site to your team the same day. Do not scratch skin that is irritated or dry — ask your team for a safe moisturiser instead.
Ask before taking any medicine, supplement, or herbal remedy
Some medicines available over the counter — including pain relievers and cold remedies — can reduce fever, which is the main warning sign of a serious infection. Masking a fever delays treatment that could save your life. Some herbal preparations, Ayurvedic medicines, and nutritional supplements also interact with chemotherapy or affect your blood count in ways that are not always predictable. Tell your team everything you are taking, including traditional remedies and vitamins, before you take them. This is not a judgement — it is information your team needs to keep you safe.
Did you know?
Neutropenic fever can progress to life-threatening sepsis within hours of onset — faster than most other oncological emergencies.
NCCN and ASCO guidelines classify it as an emergency requiring urgent treatment immediately after hospital assessment. Delay is the single factor most within your control.
Source: NCCN Clinical Practice Guidelines in Oncology: Prevention and Treatment of Cancer-Related Infections
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Frequently asked questions
What temperature should I go to hospital for during chemotherapy?
NCCN and ASCO guidance defines neutropenic fever as a temperature of 38°C or above in a person with a low white cell count, and that is the emergency threshold during chemotherapy. Do not wait to see if it settles, and do not take medicine to bring it down first. If you cannot find a thermometer or are unsure how to read it, treat any sudden feeling of fever, chills, or shaking as a reason to call your team or go directly to hospital.
Can I take paracetamol if I have a fever during chemotherapy?
Do not take paracetamol or any fever-reducing medicine before calling your team or going to hospital. Paracetamol will lower your temperature and hide the emergency, making it harder for the treating team to assess how serious your infection is. This is one of the most common mistakes that delays treatment. Once you are at the hospital and being assessed, your team will decide if and when any medicine is appropriate.
What if my fever starts at night or on a weekend?
This is exactly the situation your oncology team plans for. Neutropenic fever does not follow clinic hours, and no responsible team expects you to wait until the next working day. Your team should have given you an after-hours emergency contact number when you started chemotherapy. If you cannot find it, go to the nearest emergency department immediately and say you are on chemotherapy with a fever. Do not wait until morning.
Will my blood count definitely fall during chemotherapy?
Most chemotherapy regimens cause some fall in the blood count, but the extent varies by the drugs, the doses, and your individual response. Some people experience only a mild, brief dip. Others reach very low counts that need close monitoring or additional support. Your team will check your blood count regularly throughout treatment and will tell you which days of your cycle carry the highest risk, so you know when to be most alert.
How long does the high-risk period last after each chemotherapy cycle?
The highest-risk period is usually the second week after a chemotherapy dose, when counts are typically at their lowest — what your team calls the nadir. In most regimens, counts begin recovering towards the end of that second week, but the exact timing depends on which drugs you are receiving and how your own body responds. Your team will tell you the specific days in your cycle to watch most carefully, and when to come in for your next blood count check.
Can I see friends and family or go out while my count is low?
You can still have visitors and go out, but some precautions are worth taking during the high-risk days of your cycle. Avoid crowded indoor spaces and anyone with a cough, cold, or stomach upset during that period. Being outdoors in fresh air with a small number of healthy people is generally lower risk than a busy market or bus. Ask your team which specific days in your cycle call for extra caution — the answer is not the same for every person or every regimen.
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