- A 68-year-old female on outpatient chemotherapy for non-Hodgkin's lymphoma presents to the Emergency Room with a temperature of 38.4 degrees Celsius. Laboratory tests reveal an absolute neutrophil count of 372/mm^3
- Fever in neutropenic patient > 38.3 degrees Celsius on single oral temp or temp > 38.0 degrees Celsius > 1 hour
- neutropenia is an absolute neutrophil count (ANC) <500/mm^3
- Causes include
- bone marrow failure or invasion
- systemic lupus erythematosus
- Risk factors
- cancer patient on chemotherapy
- skin breakdown
- obstruction (biliary, GI, lymphatic, urinary tract)
- Risk stratification
- low risk
- solid tumor treated as outpatient
- neutropenia <10 days
- no major comorbidity
- high risk
- high-dose chemotherapy
- hematologic malignancy
- fever may be only manifestation of infection
- pan cultures
- metabolic panel
- CT scan
- Broad spectrum antibiotics with antipseudomonal activity
- PO ciprofloxacin + augmentin
- indicated in low risk patients
- Ceftazidime, cefepime, carbapenem
- indicated as monotherapy
- aminoglycoside + antipseudomonal beta-lactam
- indicated as 2 -drug therapy
- indicated for high-risk patients or persistent fever > 3-5 days
- indicated if fever > 3 days
- Colony stimulating factors
- routine use not indicated
AVERAGE 5.0 of 1 RATINGS
Qbank (0 Questions)
Level of Evidence 5 and Other Journal Articles (includes Case Reports, Expert Opinions,
Personal Observations, and Biomechanic Studies)
Higdon ML, Higdon JA. Treatment of oncologic emergencies. Am Fam Physician. 2006 Dec 1;74(11):1873-80.
PMID:17168344 (Link to Abstract)
Gafter-Gvili A, Fraser A, Paul M, Vidal L, Lawrie TA, van de Wetering MD, Kremer LC, Leibovici L. Antibiotic prophylaxis for bacterial infections in afebrile neutropenic patients following chemotherapy. Cochrane Database Syst Rev. 2012 Jan 18;1:CD004386.
PMID:22258955 (Link to Abstract)
- First Aid for the USMLE STEP 2 CK. Le Tao. New York: McGraw-Hill Medical, 2012.
- Brochert's Crush Step 2. O'Connell, Theodore. Philadelphia: Elsevier Saunders, 2013.
- Master the Boards USMLE Step 2 CK. Fischer, Conrad. New York: Kaplan Publishing, 2012.
- Boards and Wards for USMLE Steps 2 and 3. Ayala, Carlos. New York: Lippincott Williams and Wilkins, 2012.