Febrile neutropenia: A molecular investigation

Question 1

What does AML present with?

Answer 1

All myeloid lineage blood cells reduced.

• Bleeding
• Fatigued (anaemic)
• Bruises easily
• Pale
• Recurrent infections.

Question 2

What would a bone marrow aspirate and trephine look like with AML?

Answer 2

Aspirate: One cell type, hypercellular, small size with increased nucleus size (blast cells).

Trephine: Homogeneous, Hyper cellular, with no vacuole looking things.

Question 3

What is recommended treatment for AML?

Answer 3

Chemotherapy

Question 4

What device is used for AML treatment?

Answer 4

Triple lumen catheter:

1) Blood samples
2) Drug administration
3) Spare

Question 5

What do clinical trials aim to do?

Answer 5

Reduce remission rates and improve treatment times.

Question 6

Goal of chemotherapy?

Answer 6

Eliminate leukemic cells, but treatment is non-specific so affect all fast replicating cells (hair/mucosa/other wbc’s/rbcs).

Question 7

What does a trephine look like post chemotherapy

Answer 7

Hypo-cellular, large fat deposits. Only cells left are stromal (fibroblasts etc.) - Neutropenia?

Question 8

How would febrile neutropenia present?

Answer 8

Post chemo?

EPISODIC shivers.

Question 9

Diagnoses

Answer 9

FBC - WBC’s (neutropenic? lol)

Fever?

Question 10

What would be involved in history and examination for FN?

Answer 10

Look for signs for site of infection - SOB OR COUGH (Pneumonia) - Dysuria (UTI) - Rash (Staph)

Question 11

Parthenogenesis of FN?

Answer 11

Common in neutropenic patients (Chemo)
Usually bacteria enter blood occasionally but are cleared by neutrophils.
No neutrophils in FN so high rate of bacteraemia.

Question 12

Where do infections usually arise from in FN?

Answer 12

Gut and skin commensal organisms.

Question 13

What is the implication of neutrophil count on risk of infection?

Answer 13

Very steep curve. Small increases in neutrophils in severely neutropenic patients, greatly decreases incidence of serious infection/death.

Question 14

What treatment is given to patients with FN? Why?

Answer 14

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

Question 15

What percentage of patients with FN have bacteraemia?

Answer 15

30%

Question 16

Most common causes of infection in FN?

Answer 16

Gram negative bacilli - E.coli, klebsiella, pseudomonas (why you give

Question 17

Most common causes of infection in FN?

Answer 17

Gram negative bacilli - E.coli, klebsiella, pseudomonas (why you give

GP - Staph. aures, Coag neg staph, streptococci.

Question 18

Does nursing patient in isolation reduce risk of febrile neutropenia in chemo patients?

Answer 18

Shown little benefit

Still has commensal organisms.

Question 19

Should prophylactic antibiotics be prescribed?

Answer 19

Yes, significantly reduces risk of death when compared to no intervention.

Question 20

Use of haemopoetic growth factors to reduce neutropenic impact?

Answer 20

It shortens neutropenic phase between chemo cycles, though isn’t really effective in myeloid leukaemic patients.