Low White Cell Count — During Chemotherapy
Chemotherapy lowers the white blood cells that protect you from infection. When this happens, an ordinary fever stops being ordinary. It becomes a medical emergency that needs hospital care the same day.
Medically reviewed by Dr. Owais Mohammed, Medical Oncologist · Last reviewed September 2026
- Fever is always an emergency — A temperature during chemotherapy needs hospital care the same day — not tomorrow, not after a night's rest.
- The risk peaks after each cycle — Counts fall to their lowest in the days after treatment. This is the window when infection is most dangerous.
- Your body cannot fight back normally — Fewer white cells means you cannot mount a normal defence. Symptoms that look mild can hide a serious infection.
- Acting fast changes the outcome — Neutropenic sepsis is treatable when caught quickly. Waiting is the thing that makes it dangerous.
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Chemotherapy kills cancer cells but also lowers the white blood cells that fight infection. This leaves you vulnerable to serious infection, particularly in the days after each cycle when counts fall to their lowest point. A fever during this period is a medical emergency. Go to hospital the same day — do not wait.
If a symptom below applies to you, do not wait for a callback. Call 1800-202-8726 or go to your nearest emergency department.
What should I do to protect myself when white cells are low?
- Check your temperature morning and evening — and any time you suddenly feel worse.
- Save your hospital's emergency number in your phone and carry it with you at all times.
- Do not take paracetamol, ibuprofen or any fever medicine without calling your team first. It can mask a temperature they need to know about.
- Avoid close contact with anyone who is visibly unwell with a cough, cold or active infection.
- Tell your team about any cuts, grazes or redness around drip sites, even if they look minor.
- Do not wait for your next scheduled appointment if you feel worse. Call today.
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Not sure whether this counts as an emergency?
Call the helpline. It is always better to check than to wait.
How does a low white cell count change what a symptom means?
| Symptom | Ordinarily | When white cells are low — what to do |
|---|---|---|
| A fever | Monitor at home with fluids and rest | Hospital the same day — always, every time |
| Shaking chills or sudden sweating | Often a passing viral illness | Go to the emergency department now |
| New sore throat or cough | Rest and fluids usually help | Call your team today — same day |
| Redness around a drip line or wound | Usually settles on its own | Call your team today — do not wait overnight |
| Suddenly feeling much worse | Monitor for a day | Call your team now — do not wait |
| Typically starts | Not applicable | In the days after each chemotherapy cycle, when counts fall to their lowest point |
Why is a fever on chemotherapy a medical emergency?
White blood cells are the main defence your body uses against bacteria. Chemotherapy affects them along with the cancer cells it is targeting.
When the count falls very low, your body cannot contain an infection the way it normally would. What would be a minor illness in a healthy person can spread to the bloodstream within hours. This is called neutropenic sepsis, and it can become life-threatening quickly.
The other reason fever matters so much is that your body's normal warning signs are muffled. You may feel less unwell than you actually are. Fever is sometimes the only clear signal your body can still produce.
This is why guidance from ASCO, ESMO and NCCN all treats fever during chemotherapy as requiring same-day hospital assessment — not as a symptom to watch and see.
Explore 69 more Blood Counts, Infection, Fever & Emergencies topics
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- Growth Factor Injections to Raise Your Counts
- How to Take and Record a Temperature Properly
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- Neutropenic Fever: A Medical Emergency
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- Recovering Counts Between Cycles
- Should You Take Paracetamol for a Fever?
- Signs of Infection to Watch For
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- Visitors When Your Counts Are Low
- What Happens When You Go In With Neutropenic Fever?
- What Is Neutropenia?
- What Is an Absolute Neutrophil Count?
- What Temperature Means You Must Go to Hospital?
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- Problems With Your Port or Line
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Fever During Chemotherapy
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- Fever After the Course Has Finished
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- Fever When You Cannot Reach Your Team
- Fever With Chills and Rigors
- Fever With No Other Symptoms
- Fever in a Child on Chemotherapy
- How Long Will You Be Admitted for a Fever?
- Is 99, 100 or 101 Degrees an Emergency?
- Preventing Infection to Avoid Fever Episodes
- What to Carry to Hospital With a Fever
- What to Tell the Hospital When You Call
- Why Fever Is Treated as an Emergency
HUB — Low Blood Counts, Infection and Fever During Chemotherapy
Infection Prevention at Home
Low Platelets & Bleeding
- A Printable Bleeding Red-Flag Card
- Arranging Platelet Donors
- Bleeding Gums and Nosebleeds
- Bruising Easily During Chemotherapy
- Dental Work and Procedures With Low Platelets
- Everyday Precautions With Low Platelets
- Foods That Are Said to Raise Platelets
- Low Platelets During Chemotherapy
- Painkillers to Avoid When Platelets Are Low
- Platelet Transfusion: What to Expect
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Vaccination During & After Chemotherapy
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Frequently asked questions
What is neutropenia?
Neutropenia is the medical name for a low white blood cell count — specifically a drop in neutrophils, which are the cells that fight bacterial infection. When a fever occurs alongside a low count, this is called neutropenic fever. That combination is what makes a temperature during chemotherapy a medical emergency rather than an ordinary illness to manage at home. Your team will use blood tests to monitor your count throughout your treatment.
When during my chemotherapy cycle am I most at risk?
White cell counts typically fall to their lowest in the days after each chemotherapy cycle — a point your team may call the nadir. Exactly when this happens depends on the drugs you are receiving, so ask your team to tell you the at-risk window for your specific regimen. Write those days on your calendar. Treat any fever or sudden worsening during that period as an emergency. Counts usually recover before your next cycle, and your team confirms this with a blood test.
Will my white blood cells go back to normal?
Yes, for most people and most treatments. White cell counts typically recover between cycles, which is why chemotherapy is given in cycles rather than continuously. Your team checks a blood count before each cycle to confirm you are safe to continue. If counts take longer to recover than expected, your next cycle may be delayed or your dose adjusted — both are routine decisions intended to keep you safe, not signs that something has gone seriously wrong.
Can I go out and be around other people?
During your at-risk days, it makes sense to avoid crowded enclosed spaces and close contact with anyone who is visibly unwell. Most people on chemotherapy can continue ordinary daily activities with some care — the aim is not to isolate yourself completely, but to reduce unnecessary exposure during the window when your counts are lowest. Ask your oncologist or nurse to name your specific at-risk days so you know exactly when to take extra care.
Chemotherapy Topics
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