[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Nursing](https://durgical.com/en/nursing/) › [Medical–surgical nursing](https://durgical.com/en/nursing/areas/med-surg/) › Neutropenia and low platelets: infection and bleeding precautions, and fever as an emergency # Neutropenia and low platelets: infection and bleeding precautions, and fever as an emergency - Safe practice With few neutrophils a fever is an emergency; with few platelets small injuries bleed: the nurse prevents both and acts fast on warning signs. Updated Nov 13, 2026 ## Key points - A temperature of 38 °C or higher during chemotherapy is a medical emergency: report it at once. - Fever can be the only sign of infection in neutropenia; also watch for chills, a new cough, sore throat, mouth sores, burning on urination, diarrhoea and redness at a line or wound. - Hand hygiene by everyone who touches the patient is the main prevention; visitors with infections stay away. - Low platelets: soft toothbrush, electric razor, no enemas or suppositories, and no aspirin or anti-inflammatory medicines unless the team approves. - Report bleeding gums, nosebleeds that do not stop, new bruises or small red-purple spots, blood in urine, stool or vomit, and severe headache or vision changes. ## What it is After chemotherapy the neutrophil count often falls to its lowest point about one to two weeks after treatment, and the platelet count can fall too. With few neutrophils, germs that normally live on the skin, in the mouth and in the gut can cause severe infection, and fever may be the only sign. With few platelets, ordinary activities can cause bleeding. The nurse protects the person with hand hygiene and the unit's neutropenic precautions, takes the temperature whenever the person feels unwell, treats a fever as an emergency, prevents injuries and watches for bleeding. The immunology of neutropenic precautions is on its own page. ## What it requires - Knowing when the person's counts are expected to be lowest. - A working thermometer and a temperature check any time the person feels warm, chilled or unwell. - Hand hygiene, safe food and the precautions of the institutional neutropenia protocol. - A daily look at the skin, mouth, line sites and wounds for infection or bleeding. - Injury prevention and teaching on what to do if bleeding starts. ## How it is applied (and why) - Clean your hands before and after every contact and make sure visitors do too — hands are the main route of germs to the patient. - Take the temperature whenever the person feels warm, chilled or unwell, not only at set times — fever may be the only sign of infection. - Report a temperature of 38 °C or more at once and prepare for blood cultures as ordered — a fever during chemotherapy is a medical emergency. - Inspect the mouth, skin, perineum and line and wound sites each shift — redness, pain or swelling may be the only local sign of infection. - Avoid enemas, suppositories and rectal examinations — bleeding and infection guidance for these patients advises against them. - Keep the person away from visitors with colds and from crowds, and follow the unit's rules on food, plants and flowers — this lowers exposure. - With low platelets, offer a soft toothbrush, an electric razor and a nail file, and advise shoes and care with knives — small injuries can bleed a lot. - Check with the team before any medicine, herb or supplement, especially aspirin and anti-inflammatories — they make platelets work less well. - If bleeding starts, press firmly with gauze and ice; for a nosebleed sit up, lean forward and pinch below the bridge — then report it. ## In nursing practice - At the emergency department, the person should say they are on chemotherapy and may have an infection, so that they are seen quickly. - Keep a list of all signs of infection on the care plan and teach them to the person and family before discharge. - Bleeding that does not stop after about 10 minutes of pressure, or a nosebleed lasting more than about 30 minutes, needs urgent review. - Report at once a severe or persistent headache, or blurred or double vision, in a person with low platelets. - Prevent constipation with fluids and fibre as allowed. ## Common mistakes - Giving a fever-reducing medicine and waiting, instead of reporting the fever at once. - Giving an enema or suppository to a patient with low counts. - Relying on alcohol gel alone while visitors with colds come in and out. - Forgetting that line sites and the mouth are frequent sources of infection. - Letting a patient with low platelets shave with a blade or cut nails with clippers. ## Test yourself Think of the answer, then tap the question to see it. ## What temperature counts as fever, and an emergency, in a patient on chemotherapy? 38 °C or higher; it is a medical emergency and must be reported at once. ## When is the neutrophil count often lowest after chemotherapy? Often about 7 to 12 days after treatment, although the timing varies with the drugs given. ## Which bleeding precautions apply to a patient with low platelets? A soft toothbrush, an electric razor, and no enemas or suppositories; also no aspirin or anti-inflammatories unless the team approves. ## What should the nurse do for a nosebleed in a patient with low platelets? Sit the person up leaning forward, pinch the nose just below the bridge, apply ice wrapped in a cloth and report it, especially if it does not stop. [Add to my cards (4)](https://durgical.app/estudiar/?add=/en/nursing/neutropenia-and-low-platelets-infection-and-bleeding-precautions-and-fever-as-an/) ## Elsewhere in DurgiPedia - [The neutropenic and immunosuppressed patient (nursing)](https://durgical.com/en/immunology/the-neutropenic-and-immunosuppressed-patient/) ## Connections ## Related 4 - [Hand hygiene: the five moments and the technique](https://durgical.com/en/nursing/hand-hygiene-the-five-moments-and-the-technique/) - [Blood cultures: technique that avoids contamination](https://durgical.com/en/nursing/blood-cultures-technique-that-avoids-contamination/) - [Cancer emergencies on the ward: cord compression, SVC syndrome, high calcium and tumour lysis](https://durgical.com/en/nursing/cancer-emergencies-on-the-ward-cord-compression-svc-syndrome-high-calcium-and-tu/) - [Bleeding and clotting disorders: haemophilia, ITP and watching for DIC](https://durgical.com/en/nursing/bleeding-and-clotting-disorders-haemophilia-itp-and-watching-for-dic/) ## Related conditions 3 - [Febrile neutropenia](https://durgical.com/en/conditions/febrile-neutropenia/) - [Neutropenia and drug-induced agranulocytosis](https://durgical.com/en/conditions/neutropenia-and-drug-induced-agranulocytosis/) - [Immune thrombocytopenia (ITP)](https://durgical.com/en/conditions/immune-thrombocytopenia/) [← All of nursing](https://durgical.com/en/nursing/) Educational content for students; it does not replace your institution's protocols, supervised clinical training or a prescriber's order. Dose-calculation examples use made-up numbers: they are educational, not a clinical order. Sources: [Preventing Infections in Cancer Patients: Watch Out for Fever](https://www.cdc.gov/cancer-preventing-infections/patients/fever.html) (Centers for Disease Control and Prevention (CDC), 2025); [Preventing Infections in Cancer Patients: Know the Signs and Symptoms of Infection](https://www.cdc.gov/cancer-preventing-infections/patients/symptoms.html) (Centers for Disease Control and Prevention (CDC), 2025); [Low white blood cell count and cancer: MedlinePlus Medical Encyclopedia](https://medlineplus.gov/ency/patientinstructions/000675.htm) (MedlinePlus, US National Library of Medicine, 2026); [Bleeding during cancer treatment: MedlinePlus Medical Encyclopedia](https://medlineplus.gov/ency/patientinstructions/000022.htm) (MedlinePlus, US National Library of Medicine, 2026). ## **Spotted a mistake?** We are always improving for the community. Tell us what is wrong and our team will review it. Report a mistake Representative model, for educational purposes only. --- Source: https://durgical.com/en/nursing/neutropenia-and-low-platelets-infection-and-bleeding-precautions-and-fever-as-an/ License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/nursing/neutropenia-and-low-platelets-infection-and-bleeding-precautions-and-fever-as-an/