Neutropenic Diet Pdf

Policy Statement - Neutropenic Dietary Advice for Haematology PatientsSummaryThis BDA Policy Statement 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.

• Neutropenic Precautions
• Neutropenic Diet Precautions

Neutropenic Precautions

IntroductionAfter 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 streamThe ‘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). However an UK audit of neutropenic dietary advice revealed a variety of practices continue (2).

Many well established units still follow tradition and restrict intake of multiple foods highlighting the need for consensus regarding the advice given.Due to concerns regarding inconsistent and inappropriate dietary advice during neutropenia, the Haematology Group of the British Dietetic Association established recommendations that were published by Leukaemia and Lymphoma Research in 2007 (3). 5 years later our group recognised that the evidence for this guidance needs to be re-visited. Further literature search and consultation has now led to updated recommendations.

These are shown, according to the level of neutropenia in tables 1 and 2. The following article highlights some of the more contentious areas and summarises changes to the previous advice which have been summarised in table 3. AimsTo standardize neutropenic dietary advice provided to haematology patients undergoing treatment throughout the United Kingdom using evidence/ best practice guidelines. ObjectiveTo enable dietitians working with haematology patients to confidently be able to advise about neutropenic dietary restrictions.

Neutropenic Diet Precautions

Recommendations Reheating food and ricePrevious advice to avoid reheating cooked food was reviewed in the context of known risk and potential benefit to the patient. There was no evidence that correctly reheated food, increases food poisoning risk in immunocompromised individuals.

Therefore guidance on cooling, storing and reheating cooked food safely has been added to the recommendations. The exception to this advice is reheating cooked rice. The spores of Bacillus cereus and Bacillus subtilis found in rice, survive the cooking process. These develop into bacteria that multiply very quickly at ambient temperatures and may not be adequately killed during reheating.

Therefore rice should be served hot and eaten immediately after it is first cooked. WaterThere was no evidence to support any change to the existing recommendations regarding water. Campylobacter has been found and can flourish in bottled and mineral water (4-6) and Legionella, Pseudomonas aeruginosa and Pseudomonas fluorescens have been isolated from commercially available bottled still water (5;7;8). Non-carbonated bottled water may also contain large amounts of gram negative bacteria such as Stenotrophomonas maltophillia (9). Therefore recommendations continue to support avoiding non-carbonated bottled water, mineral water and water from fresh wells during neutropenia 0.5 provided it was consumed within 24 hours of opening. This is in line with the FSA advice to other vulnerable groups i.e. Pregnant women, where ready to eat smoked fish is not restricted (27).

Due to uncertainty surrounding risk from low levels of bacteria the group have continued to recommend avoidance of ready to eat smoked fish where neutrophils.