Febrile Neutropenia

Question 1

Definition of Febrile Neutropenia

Answer 1

NF is defined as Neutropenia
ANC of < 0.5 x 10 cells/L or an
ANC < 1 x 10 cells/L with a predicted decrease to <0.5 over the next 48 Hr

and a single oral temperature ≥ 101°F (≥ 38.3°C) or ≥ 100.4°F (≥ 38°C) sustained over 1 hour

Question 2

What is Profound Netropenia

Answer 2

Profound neutropenia = < 0.1 x 109 cells/L

Question 3

What is Prolonged Neutropenia

Answer 3

Prolonged neutropenia = ≥ 7 days

Question 4

What Is the Principle of FN (6)

become comfortable understanding the Princliples of FN

Answer 4

A. Neutropenia occurs frequently in patients receiving chemotherapy
B. Neutropenic patients are at an increased risk of developing serious infections
C. Signs and symptoms of infection are often absent, but fever remains an early but nonspecific sign
D. Prevention and management of FN is critical as it is a common source of morbidity and mortality in cancer patients (considered an oncologic emergency)
E. FN occurs in 10-50% of patients with solid tumors, and > 80% of those with a hematologic malignancy
F. Primary sites of infection are the alimentary tract (mouth, pharynx, esophagus, large and small bowel, and rectum), urinary tract, lungs, sinuses, skin, intravascular device, and bloodstream

Question 5

Workup of FN

Answer 5

A. In the absence of an alternative explanation, clinicians should assume that fever in a patient with neutropenia from cancer chemotherapy is the result of an infection
B. Initial diagnostic approach should maximize the chances of establishing clinical and microbiological diagnoses that may affect antibacterial choice; recommendations are outlined in the table below

Question 6

Work up for FN (CHART)

Answer 6