Cancer Complications: neutropenic sepsis Flashcards
What are the two main factors that suggest neutropenic sepsis?
Temp > 38
Neutrophil count < 0.5x10*9/L
In what type of patients should you suspect neutropenic sepsis?
ALL chemotherapy patients who become unwell
Do all patients with neutropenic sepsis have a fever?
No - can be masked by steroids
What symptoms are associated with neutropenic sepsis?
Fever Flu like symptoms Confusion Sweating Symptoms related to specific system effected: sore throat, diarrhoea, SOB
What signs are associated with neutropenic sepsis?
HR>90 BP<90 RR>22 Impaired MMSE Signs of infection - check Hickman/ PICC lines, wounds, mouth, catheter site
What pathogens are most frequently associated with neutropenic sepsis?
Staph aureus
Staph epidermidis
Enterococcus
Streptococcus
(80% arise from endogenous flora)
If you are suspecting neutropenic sepsis, what investigations should be done?
Bloods: FBC, U&E, LFTs, CRP, lactate
Cultures: blood (central and peripheral), urine, stool, sputum, lines, wounds, viral serology
ABG
Imaging: CXR, AXR, ECHO, LP
What are the management steps for neutropenic sepsis?
SEPSIS SIX
- oxygen, fluids and antibiotics (empiric IV broad spectrum within the hour)
- lactate, blood culture, urine output
GCSF if profoundly neutropenic (granulocyte colony stimulating factor)
What is the normal neutrophil range?
2-7.5x10*9/L
When does the typical neutrophil nadir occur?
10 to 14 days post chemotherapy
Which type of malignancy typically has the greatest duration of neutropenia?
Haematological malignancies
What preventative measures can be implemented for neutropenic sepsis?
Patient education - who to call if unwell, carry an alert card Prophylactic antibiotics For future cycles: Consider dose reduction of chemotherapy Prophylactic GCSF Stop treatment?
