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E CAN ext. > Febrile Neutropenia > Flashcards

Febrile Neutropenia Flashcards

1
Q

When is febrile netropenia most often seen?

A

As a result of cytotoxic therapy

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2
Q

When does the neutrophil count usually reach its lowest level?

A

5-10 days after the last dose of chemotherapy

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3
Q

Other than after cytotoxic therapy, when can neutropenia occur in cancer?

A
  • After radiotherapy

- Part of pancytopenia

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4
Q

When can neutropenia follow radiotherapy?

A

When large volumes of bone marrow are irradiated

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5
Q

Why might cancer cause pancytopenia?

A

Due to malignant infiltration of the marrow

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6
Q

What is febrile neutropenia defined as?

A
  • Oral temperature of 38.5 or above, and 2 consecutive readings of 38 or above for 2 hours
  • Absolute neutrophil count of 0.5x10^9/L or less
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7
Q

When should there be a high index of suspicion for febrile neutropenia?

A

In all patients who have recently received chemotherapy

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8
Q

What is the significance of fever in a cancer patient?

A

Although there are other causes of fever in a cancer patient, infection should always be assumed unless proven otherwise

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9
Q

Are the signs and symptoms of febrile neutropenia significant?

A

No, they can be minimal

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10
Q

When in particular might the signs and symptoms of febrile neutropenia be minimal?

A

In patients on corticosteroids

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11
Q

What should the history include in febrile neutropenia?

A
  • Whether the patient belongs to a high risk group
  • Duration since last chemotherapy cycle (if applicable)
  • Any recent blood produces
  • Any intravascular devices, e.g. cannula, central lines
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12
Q

What are the high risk groups for febrile neutropenia?

A
  • Active neoplastic disease
  • Recent course of chemotherapy
  • Immunosuppressant therapy
  • Immunosuppressive illness, e.g. HIV
  • CKD
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13
Q

What laboratory investigations should be done in febrile neutropenia?

A

Infection screen comprising of;

  • Blood cultures
  • MSU
  • Chest x-ray
  • Swabs for cultures
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14
Q

What blood cultures should be done in febrile neutropenia?

A
  • Peripheral

- Central line if present

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15
Q

What swabs should be done in febrile neutropenia?

A
  • Throat

- Central line site

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16
Q

Are additional microbiological assessments required in febrile neutropenia?

A

Not unless there are localising signs of infection

17
Q

What is the basic management of febrile neutropenia?

A

Sepsis 6 bundle

18
Q

What should choice of empirical antibiotics be based on in febrile neutropenia?

A

Local hospital policies, agreed with microbiologists and based on local antibiotic resistance patterns

19
Q

What is first line empirical antibiotic therapy in febrile neutropenia?

A

Either monotherapy with tazocin or meropenum, or with the addition of gentamicin

20
Q

What can be added to empirical antibiotic therapy for febrile neutropenia when anaerobic infection is present?

A

Metronidazole

21
Q

What can be added to empirical antibiotic therapy for febrile neutropenia when gram-positive infection is suspected?

A

One of;

  • Flucloxacillin
  • Vancoymycin
  • Teicoplanin
22
Q

What should empirical antibiotics be adjusted on the basis of?

A

Culture results

23
Q

What is the problem with determining suitable antibiotics from culture results in febrile neutropenia?

A

Cultures are often negative

24
Q

What should be done if there is no response to antibiotics after 36-48 hours in febrile neutropenia?

A
  • Antibiotics should be reviewed with microbiological advice
  • Anti-fungal cover should be considered
25
Q

What does recombinant human granulocyte-colony stimulating factor (G-CSF) do?

A

Stimulates the production of neutrophils in the bone marrow

26
Q

How is G-CSF administered?

A

SC

27
Q

What is the purpose of G-CSF?

A

It may reduce the duration of chemotherapy-induced neutropenia, and thereby reduce the incidence of associated sepsis

28
Q

Does G-CSF improve survival?

A

Currently no evidence that it improves survival

29
Q

Can G-CSF be used prophylactically?

A

In some cases, but not routinely

30
Q

Give an example of when G-CSF might be used prophylactically in some cases?

A

Following chemotherapy

31
Q

When can G-CSF be used in an established infection?

A

Can be given alongside antibiotics to counteract infection

32
Q

What is the mortality from febrile neutropenia in people with solid tumours?

A

5%

33
Q

What is the mortality from febrile neutropenia in people with haematological malignancies?

A

11%

34
Q

What does successful management of febrile neutropenia depend on?

A

Early recognition

35
Q

How can early recognition of febrile neutropenia be achieved?

A
  • Patients should be educated to monitor their symptoms, including body temperature
  • Should be given clear, written instructions on when and how to contact appropriate services in the event of concerns

E CAN ext. (47 decks)

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