Febrile Neutropenia
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Introduction
fever: a single oral temperature over 38.5 C, or 2 in 12 hours of over 38.0 C
neutrophil count less than 500/mm3(0.5x109) or predicted to get there soon
The Case of...
a simple case introducing clincial presentation and calling for a differential diagnosis to get students thinking.
Causes and Risk Factors
Factors that lower risk of severe infection among people with neutropenia:
- ANC above 100 cells/mm3
- AMC ditto
- normal CXR
- nearly normal hepatic and renal tests
- neutropenia duration of less than 7 days
- no IV/catheter infection
- early evidence of bone marrow recovery
- malignancy in remission
- peak temp below 39 C
- no neurological or mental changes
- no appearance of illness
- no abdominal pain
- no comorbidity complications
Pathophysiology
Signs and Symptoms
- history
- physical exam
History
Thorough examination and history often reveal:
- malignancy
- past history of infection or potential contact
- drug therapy
- allergies
- immunizations
- renal failure
- involvement of skin: perianal, mouth, chest, abdomen, etc
Physical Exam
Investigations
- lab investigations
- diagnostic imaging
Lab Investigations
absolute neutrophil count, lymphocyte count, renal function, and liver function tests may all be done
central and peripheral blood cultures
Diagnostic Imaging
chest X ray
Differential Diagnosis
Treatments
Prevention of many infections is often possible, primarily by hand washing.
antibacterial, antifungal, and antiviral prophylaxis may be used in some.
Treating febrile neutropenia can be done in many ways.
Choices include:
- emperic vs specific
- PO vs IV
- broad spectrum
- antibacterial? antifungal? antiviral
Consequences and Course
Resources and References
Topic Development
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