Febrile neutropenia: A molecular investigation Flashcards
What does AML present with?
All myeloid lineage blood cells reduced.
- Bleeding
- Fatigued (anaemic)
- Bruises easily
- Pale
- Recurrent infections.
What would a bone marrow aspirate and trephine look like with AML?
Aspirate: One cell type, hypercellular, small size with increased nucleus size (blast cells).
Trephine: Homogeneous, Hyper cellular, with no vacuole looking things.
What is recommended treatment for AML?
Chemotherapy
What device is used for AML treatment?
Triple lumen catheter:
1) Blood samples
2) Drug administration
3) Spare
What do clinical trials aim to do?
Reduce remission rates and improve treatment times.
Goal of chemotherapy?
Eliminate leukemic cells, but treatment is non-specific so affect all fast replicating cells (hair/mucosa/other wbc’s/rbcs).
What does a trephine look like post chemotherapy
Hypo-cellular, large fat deposits. Only cells left are stromal (fibroblasts etc.) - Neutropenia?
How would febrile neutropenia present?
Post chemo?
EPISODIC shivers.
Diagnoses
FBC - WBC’s (neutropenic? lol)
Fever?
What would be involved in history and examination for FN?
Look for signs for site of infection - SOB OR COUGH (Pneumonia) - Dysuria (UTI) - Rash (Staph)
Parthenogenesis of FN?
Common in neutropenic patients (Chemo)
Usually bacteria enter blood occasionally but are cleared by neutrophils.
No neutrophils in FN so high rate of bacteraemia.
Where do infections usually arise from in FN?
Gut and skin commensal organisms.
What is the implication of neutrophil count on risk of infection?
Very steep curve. Small increases in neutrophils in severely neutropenic patients, greatly decreases incidence of serious infection/death.
What treatment is given to patients with FN? Why?
Empiric antibiotics - As there is no time to find causative as risk of infection/death is prolonged in patients with prolonged, severe neutropenia.
Tazocin - for aerobic anti biotics
Gentamicin - for all aerobic gram negative bacilli
What percentage of patients with FN have bacteraemia?
30%
Most common causes of infection in FN?
Gram negative bacilli - E.coli, klebsiella, pseudomonas (why you give
Most common causes of infection in FN?
Gram negative bacilli - E.coli, klebsiella, pseudomonas (why you give
GP - Staph. aures, Coag neg staph, streptococci.
Does nursing patient in isolation reduce risk of febrile neutropenia in chemo patients?
Shown little benefit
Still has commensal organisms.
Should prophylactic antibiotics be prescribed?
Yes, significantly reduces risk of death when compared to no intervention.
Use of haemopoetic growth factors to reduce neutropenic impact?
It shortens neutropenic phase between chemo cycles, though isn’t really effective in myeloid leukaemic patients.
