Febrile Neutropenia

Question 1

What is febrile neutropenia?

Answer 1

• Oral temperature ≥38.5°C
  
  • ​or
• Two consecutive readings of ≥38.0°C for 2 hours​

and

• Absolute neutrophil count ≤0.5 x 109/L
  
  • ​or
• Expected to fall below 0.5 x 109/L

Question 2

What history should be be taken when considering febrile neutropenia?

Answer 2

• Is patient high risk?
  
  • Eg. HIV, Chemotherapy
• Chronic kidney disease
• IV devices?

Question 3

What examination should be carried out for febrile neutropenia?

Answer 3

• Cardiac systems
• Respiratory systems
• General examination

Question 4

What investigations should be carried out for febrile neutropenia?

Answer 4

• FBC (current neutrophil level)
• Blood cultures
• If potentially septic:
• Blood film
• D-dimer
• Fibrinogen : (look for DIC)
• U&E, creatinine
• LFTs
• CRP
• Sputum, urine, skin swabs and stool specimens where clinically indicated.

Question 5

How should febrile neutropenia be managed?

Answer 5

IV antibiotics

Monitor closely

Question 6

What’s the prognosis like for patients with febrile neutropenia and proven bacteriaemia

Answer 6

18% in Gram-negative

5% in Gram-positive bacteraemia