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 febrile neutropenia.
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- 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.