Febrile neutropenia resident survival guide

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.

• Life threatening cause 1
• Life threatening cause 2
• Life threatening cause 3

Common Causes

• Common cause 1
• Common cause 2
• Common cause 3
• Common cause 4
• Common cause 5

Management

Shown below is an algorithm summarizing the approach to febrile neutropenia.

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.

References

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