Febrile Neutropenia

Question 1

What treatment is recommended for acute myeloid leukaemia?

Answer 1

Chemotherapy

Question 2

Classic presentation of patient with febrile neutropenia?

Answer 2

11 days after starting her chemotherapy reports with two episodes of uncontrollable shivering each lasting about 30mins

Question 3

Why is it often hard to find the site of infection in febrile neutropenia?

Answer 3

The normal sings that tell us where infection normally is is due to the inflammatory response e.g. red swollen leg or pneumonia

Question 4

FN infections often arise from

Answer 4

from damaged barriers in the gut and skin

Question 5

FN high mortality in?

Answer 5

patients with gram negative bacteria (without emperic Rx)

Question 6

FN improved outcomes with?

Answer 6

empiric antibiotic treatment started at presentation

Question 7

Risk of infection related to neutrophil count?

Answer 7

Risk rises below 0.5x10^9/L
>1% daily risk of bacteraemia with neutrophil count <0.1x10^9
The long the patient has a WBC below 0.1… by ~4 weeks you have 100% chance of infection

Question 8

About what percentage of patients with FN are bacteraemic?

Answer 8

30%

Question 9

Febrile neutropenia since the 1960’s

Answer 9

gram negative bacteria remain common causes, gram positive cocci have increased
Emperic antibiotic therapy standard changing empiric antibiotic regimens
Use of antibiotic prophylaxis to prevent infection
Much greater care about IV lines etc to prevent infection

Question 10

Common investigations of a FN patient

Answer 10

blood cultures: from central line and peripheral vein
Swab skin and mouth lesions
CXR, check lung fields, cardiac and mediastinal contours

Question 11

Example of initial management of FN patient

Answer 11

Tazocin - active against almost all aerobic bacteria

Gentamicin - active against almost all gram negative bacilli

Question 12

Strategies to reduce neutropenic fever with further therapy?

Answer 12

• nurse the patient in isolation? can reduce days of fever but no impact in overall survival rate
• Use of prophylactic antibiotics? no too much concern about developing resistance
• Role of haematopoietic growth factors e.g. granulocyte colony stimulating factor, reduce the period and depth of neutropenia
• reducing intensity of subsequent course of chemo