Neutropenic Sepsis

Question 1

Define Neutropenic Sepsis

Answer 1

Potentially life-threatening complication of neutropenia

Temperature of greater than 38°C or any symptoms and/or signs of sepsis, in a person with an absolute neutrophil count of 0.5 x 109/L or lower.

Question 2

Aetiology of Neutropenic Sepsis

Answer 2

Drugs and treatments: Cytotoxic chemotherapy (febrile neutropenia is one of the most frequent and serious complications) | Immunosuppression | Haematopoietic stem cell transplantation | other drugs e.g. penicillin, carbimazole, phenytoin, valproic acid

Infection: HIV | influenza | hep B | RSV | CMV | EBV | TB | shigella

Autoimmune: Crohn’s | rheumatoid arthritis | SLE

Bone marrow disorders: Aplastic anaemia |myelodysplastic syndrome | acute leukaemia

Nutritional deficiency: B12 and folate

Question 3

Symptoms of Neutropenic Sepsis

Answer 3

Chills, shivers, rigors
Fever > 38 OR hypothermia (+ drugs like corticosteroids may mask a high temp)
Systemic sepsis: malaise, agitation, behavioural change, mental state or cognition change
- Delirium e.g. not responding normally to social cues or waking only with prolonged stimulation, or new irritability (in children); new-onset confusion (in adults)
Specific infection features: Dysuria | Diarrhoea | Productive cough

Question 4

Signs of Neutropenic Sepsis

Answer 4

Fever > 38 OR hypothermia (+ drugs like corticosteroids may mask a high temp)
Dehydration: reduced urine output, dry mucous membrane, poor skin turgor
Respiratory distress: Nasal flaring, grunting, and apnoea in children less than 5 years of age
Hypotension
Mottled or ashen skin; pallor or cyanosis of the skin, lips or tongue; cold peripheries.
Assess GCS/AVPU

Question 5

Investigations for Neutropenic Sepsis

Answer 5

FBC: absolute neutrophil count of 0.5 x 109/L or lower, WCC high or low

Blood gas: Hyperlactataemia, hypo/hyperglycaemia
Blood cultures: causative organism (BEFORE Abxs)
CRP: raised
U+Es: Indication of dehydration (raised Cr and U)
LFTs: Increased bilirubin or ALT levels may indicate cholestasis or other liver dysfunction that is chemo induced
Clotting screen: abnormal in coagulopathies/DIC
Urine output: sepsis protocol

Find cause of infection:
Urine analysis and culture
Sputum analysis and culture
CXR
CT chest
Bronchoalveolar lavage