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.
Common Causes
Management
Shown below is an algorithm summarizing the approach to [[disease name]].
| Fever > 101 for 1 hour or > 100.4 sustained for > 1 hour in patient with ANC <500 in with systemic chemotherapy within a month | |||||||||||||||||||||||||||||||||
| Low risk of serious complications | High risk of serious complications | ||||||||||||||||||||||||||||||||
| Neutropenia for <7 days, no active comorbidities, no evidence of end organ dysfunction | Absolute neutrophil count <500 for >7 days, active comorbidities, evidence of end organ dysfunction | ||||||||||||||||||||||||||||||||
| Outpatient antibiotics used if patient is able to tolerate | Absolute neutrophil count <500 for ≤7 days, no active comorbidities, no evidence of end organ dysfunction | ||||||||||||||||||||||||||||||||
| Ciprofloxacin with augmentin preferred | |||||||||||||||||||||||||||||||||
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.