Febrile neutropenia resident survival guide: Difference between revisions
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'''Labs every 3 days during the course of antibiotics:'''<br> | '''Labs every 3 days during the course of antibiotics:'''<br> | ||
❑ [[CBC]]<br> | ❑ [[CBC]]<br> | ||
❑ [[Electrolytes]] <br> | |||
❑ [[Creatinine|Serum creatinine]]<br> | ❑ [[Creatinine|Serum creatinine]]<br> | ||
❑ [[BUN]]<br> | ❑ [[BUN]]<br> | ||
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❑ MASCC score* <21, OR <br> | ❑ MASCC score* <21, OR <br> | ||
❑ Anticipated prolonged neutropenia (> 7 days) AND profound neutropenia (ANC≤100 cells mm<sup>3</sup>), OR <br> | ❑ Anticipated prolonged neutropenia (> 7 days) AND profound neutropenia (ANC≤100 cells mm<sup>3</sup>), OR <br> | ||
❑ Presence of comorbidities </div>}} | ❑ Presence of comorbidities </div>}} | ||
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Revision as of 02:16, 23 December 2013
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Definition
Fever in a neutropenic patients is defined as one oral temperature of >38.3°C (101°F) or a temperature of >38.0°C (100.4°F) for >1 hour. Neutropenia is defined as an absolute neutrophil count (ANC) <1500 cells/microL. Severe neutropenia is defined when the ANC <500 cells/microL, or an ANC that is expected to decrease to <500 cells/microL over the next 48 hours. Clinically significant infections usually occurs with severe neutropenia
Causes
Life Threatening Causes
Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated.
Common Causes
Management
Shown below is an algorithm summarizing the approach to febrile neutropenia.
Confirm fever and neutropenia: ❑ Single oral temperature ≥38.3°c (1010.4°F), OR | |||||||||||||||||||||||||||||
Obtain a detailed history: ❑ New site specific onset | |||||||||||||||||||||||||||||
Examine the patient: ❑ Site of previous procedures (entry and exit sites of catheters, bone marrow aspiration site) | |||||||||||||||||||||||||||||
Order lab tests and cultures: Labs every 3 days during the course of antibiotics: Labs weekly during the course of antibiotics Cultures: Additional tests (not routine) | |||||||||||||||||||||||||||||
DO A RISK ASSESSMENT | |||||||||||||||||||||||||||||
LOW RISK ❑ MASCC score* ≥21, OR ❑ Anticipated brief neutropenia (≤ 7 days), OR ❑ Clinically stable patient, OR ❑ No comorbidities | HIGH RISK ❑ MASCC score* <21, OR | ||||||||||||||||||||||||||||
Outpatient oral antibiotics ❑ Ability to tolerate oral medications | Inpatient IV antibiotics ❑ Inability to tolerate oral medications | Inpatient IV antibiotics | |||||||||||||||||||||||||||
Administer IV monotherapy with an antipseudomonal ❑ Cefepime, OR ❑ Piperacillin/tazobactam, OR ❑ Carbapenem | |||||||||||||||||||||||||||||
Do's
- Low risk patients for serious complications - Patients expected to be neutropenic (absolute neutrophil count [ANC] <500 cells/microL) for ≤7 days with no active comorbidities or evidence of end organ dysfunction. Patients recieving chemotherapy for solid tumors are usually considered low risk.
- High risk patients for serious complications- Patients expected to be neutropenic (absolute neutrophil count [ANC] <500 cells/microL) for >7 days with active comorbidities or evidence of end organ dysfunction. Patients recieving myeloablative hematopoietic cell transplantation, and in patients undergoing induction chemotherapy for acute leukemia are considered high risks.