*Neutropenic sepsis

Question 1

Define neutropenic sepsis.

Answer 1

Temp >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

What is the most common complication of anticancer treatment?

Answer 2

Febrile neutropenia is the most common complication of anticancer treatment, and describes the presence of fever in a person with neutropenia.

Question 3

What are the causes of neutropenia?

Answer 3

• cytotoxic chemotherapy
• immunosuppressive drug
• stem cell transplantation
• infections
• bone marrow disorders e.g. aplastic anaemia and MDS
• nutritional deficiencies

Question 4

What are the complications of neutropenic sepsis?

Answer 4

• organ failure
• atypical invasive infections
• coagulopathy
• encephalopathy
• delirium
• death

Question 5

What are the clinical features of neutropenic sepsis?

Answer 5

A patient with risk factors for neutropenia who has:
* temp >38°C or chills, shivers, rigors NB: sometimes hypothermia
* signs of sepsis
* change in appearance or behaviour reported
* cough/dysuria/diarrhoea

Question 6

How do you assess a patient with suspected neutropenic sepsis?

Answer 6

ABCDE

Question 7

What investiagations should be done in neutropenic sepsis?

Answer 7

• ABG - for lactate
• Blood culture
• FBC
• CRP
• U&Es
• LFTs - check for cholestasis/liver dysfunction which may be tx induced
• Clotting - check for DIC
• Urinalysis

Question 8

What is the management of suspected neutropenic sepsis?

Answer 8

1. Immediate IV antibiotics - usually pip/taz + gentamicin. If penicillin allergy: ciprofloxacin + teicoplanin + gentamicin
2. IV fluids
3. Check serial lactate
4. Check UO, monitor fluid balance hourly and monitor closely
5. Transfer to ICU if necessary

Can check if low risk using Multinational Association of Supportive Care in Cancer (MASCC) prognostic index

+/- refer to oncology or ICU