Lecture 36: Molecular medicine-febrile neutropenia Flashcards
Clinical case #1
36 y/o married women with 2 kids aged 4 and 6 presents with:
- Slowly worsening tiredness for 6 weeks
- Unusually severe bruising for 2 weeks
- Unusual bleeding from her gums for 3 days
Lab findings: low Hb and platelets, normal WBC total (with high blast cells and low neutrophils and lymphocytes)
After bone marrow examination (both aspirate and core) she is diagnosed with acute myeloid leukaemia
Treatment reccommended is Chemotherapy - having prompt effects on her marrow and peripheral blood BUT leaving her with profound neutropenia.
11 Days after starting chemo Case 1 patient calls with uncontrolled shivering and fever of 39.9˚C
Her total WBC count < 0.1
Platelets are low and haemoglibin is 114g/L (N= 115-150)
Febrile Neutropenia
Look for cough, SOB, abdominal pain, urinary frequency of dysurua, skin lesions. Nothing in examination suggests the site of infection.
What is Febrile Neutropenia? Treatment?
- Common in severe neutropenic patients
- High rate of bacteremia
- Infections arise from endogenous gut and skin flora (eg. E coli or Staphylococcus aureus (and other staph and strep organisms)
- Very high mortality in patients with Gram negative bacteremia (withut empiric Rx)
- Improved outcome with empiric antibiotic treatment (started at presentation)
- Risk rises below 0.5 x 109/L (>1% daily risk of bacteremia with neutrophil count < 0.1 x 109/L) - 33% at 1 week and 100% at 6 weeks.
Treatment: Antiobiotics that are as broad spectrum and as potent as can be give IV stat.
What patients with febrile neutropenia look like?
There needs to neutrophils in order for the common signs of infection to appear so although a line may not look red and not swollen and not tender it may still be infected. You could have pneumonia but with no crackles and a normal CXR.
30% of patients with febrile neutropenia are bacteraemic
40% have no evidence of infection
