05 Jan 2021
This document provides guidance for the provision of consistent advice on neutropenic dietary restrictions for haematology patients. It provides evidence/ best practice guidance for haematology patients undergoing chemotherapy as well as those with more profound neutropenia undergoing stem cell/ bone marrow transplantation. This is a guideline for those units who chose to continue to advise dietary restrictions during neutropenia. It is not intended for people with neutropenia of a non- haematological cause.
After chemotherapy and stem cell transplantation, patients are at a greater risk of infection from bacteria or fungus in food. This is for the following reasons:
- The white blood cells (neutrophils) that would usually fight food poisoning bacteria are at a low level. This is called neutropenia
- The gut lining which acts as a barrier between bacteria and the bloodstream is damaged by chemotherapy and radiotherapy. This makes it easier for bacteria to cross into the blood stream.
The ‘Neutropenic Diet’ has remained a controversial area across Haematology Units in the UK. The evidence for dietary restriction during immunosuppressive therapy and/ or neutropenia is still limited and some institutions have removed restrictions without any corresponding increase in infection rates (1). Due to concerns regarding inconsistent and inappropriate dietary advice during neutropenia, the Haematology Group of the British Dietetic Association established recommendations that were first published (2) and amended five years later. Our group recognised that the evidence for this guidance needed to be re-visited, further up to date research and consultation has now led to updated recommendations.
The purpose of this statement is to:
- To standardise dietary advice provided to haematology patients undergoing treatment throughout the United Kingdom using evidence/ best practice guidelines.
- To enable dietitians working with haematology patients to confidently be able to advise about neutropenic dietary restrictions.