Febrile Neutropenia

Posted by e-Medical PPT Monday, February 27, 2012
When Does Neutropenia Occur?
Most chemotherapy agents/protocols cause neutropenia nadir at 10-14 days
But can see anytime from a few days after chemotherapy to up to 4-6 weeks later depending on the agents used

Significance of Febrile Neutropenia?
Infections in the neutropenic patient can be rapidly fatal if not managed properly
Mortality rate in the 1960’s was  50%
With proper management  5% today
Most patients don’t have bacterial infection
 30-50% will have infection
Primary sites:
 GI tract –
 Skin
Risk increases with lower counts (< 0.5 vs. < 0.1)  and duration of neutropenia
But no reliable way of knowing or predicting who is infected
So all are treated with empiric antibiotics
Fevers may be due to other infections or to non-infectious causes

Assessment
Good history and physical exam
 be aware that with  ANC may not have inflammation - so redness, swelling and infiltrates may not be seen
mouth, pharynx, lower esophagus, lung, skin, anus and perineum are often sites of infection
 Blood work - CBC, creat, BUN, liver profile
Culture
 blood cultures (include central line if present)
Other cultures only indicated if symptoms
 If diarrhea should do C. Difficile toxin
 Urine if symptoms or catheter
CXR – if outpatient therapy or if symptomatic
Other – LP, lesion aspiration, wound cultures as indicated

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