@lhick Oh golly, you’re in a bit of a predicament right now. With your neutrophil count so low having any type of surgery can be pretty risky. Especially in the anal area. Along a similar experience, when I was undergoing intensive chemo for AML, mid cycle I became severely neutropenic, ended up back in the hosptial for a week with a neutropenic fever.
Because of the also low platelet count, apparently an internal hemorrhoid, which I didn’t know existed, decided to enlarge. Well, that resulted in nothing being able to move past it! 😳 Had the urge but nothing could beyond the ‘gate keeper’!
This borders on TMI but here goes…My hematologist wouldn’t even consider allowing the nurse to give me a suppository to ease the passing. It was too risky for infection. So I had to wait until my WBC started to rise enough. 7 days! At which point the doctor came into the room all smiles telling me that he set up a ‘date’ for me with my nurse for an enema! I was actually looking forward to it! So you can imagine how constipated I was at that point. (And nervous for what was to come. LOL) Finally I was able to have an enema and, well, that’s another story!! But it came with great celebration! 😂

Anyway, that just shows the seriousness of the potential for infection when neutrophils are low. Considering the level of pain you’re in though, it’s also important for you to be able to have this fissure corrected.
I’m wondering if your hematologist might suggest Neupogen. From my understanding, Neuopogen may be given in low doses intermittently to help bring up neutrophils in compromised patients. That could possibly help to bring a more sustained level of WBC, enough for your hematologist to give you the go ahead for the surgery. It wouldn’t be a longterm application but work as a crutch to get your through surgery and recovery.

I’m so sorry you’re having to go through this. I know it’s so uncomfortable and certainly interferes with daily activities! When is the hematology consult?