Neutropenic Sepsis

Question 1

What is neutropenic sepsis classified as?

Answer 1

neutropenic count ≤ 0.5 x109
Plus one of the following:
Temp ≥ 38°C
Or
Other signs/symptoms consistent with sepsis

Question 2

What are some causes of neutropenic sepsis? (7)

Answer 2

• Recent chemotherapy – commonly within 7-10days as it causes bone marrow suppression
• Malignant bone marrow infiltration
• Extensive radiotherapy
• Bone marrow failure secondary to non-malignant disease (e.g. aplastic anaemia)
• Hypersplenism
• Megaloblastic anaemia
Drug-induced (e.g. clozapine)

Question 3

What are some risk factors of neutropenic sepsis?(10)

Answer 3

• Patients over the age of 60
• Advanced malignancy
• Previous neutropenic sepsis
• Mucositis (chemotherapy can induce mucosal damage and allow bacterial translocation)
• Poor performance status
• Significant co-morbidities (the risk increases further in the presence of multiple co-morbidities)
• Indwelling central venous catheters
• Corticosteroids (causes immunosuppression)
• Prolonged hospital admission
• Severe or prolonged neutropenia

Question 4

What is the neutrophil count for each stage in severity of neutropenia? (4)

Answer 4

1. > 1.5
2. 1-1.5
3. 0.5-1
4. <0.5

Question 5

What are the non specific symptoms of neutropenic sepsis? (7)

Answer 5

• Fatigue
• Feeling warm or cold
• Rigors or shaking
• Feeling sweaty or clammy
• Palpitations
• Dizziness
• Subjective confusion or disorientation

Question 6

What are the generic signs of neutropenic sepsis? (5)

Answer 6

• Haemodynamic instability (e.g. hypotension, tachycardia, tachypnoea, hypoxia)
• Fever
• Reduced urine output
• Altered conscious level or confusion
• Mottled/ashen appearance

Question 7

How many blood cultures are taken when investigating neutropenic sepsis?

Answer 7

at least two sets from a peripheral vein plus a set from an indwelling line if present to look for a causative organism.

Question 8

What is the first line abx for neutropenic sepsis?

Answer 8

Tazocin

Question 9

What is the second line abx for neutropenic sepsis?

Answer 9

Meropenem

Question 10

Aside from abx what other medication is given in neutropenic sepsis treatment? What is the action?

Answer 10

Recombinant granulocyte-colony stimulating factor = may be used as prophylaxis and treatment of neutropenic sepsis
• Stimulate the bone marrow to produce neutrophils
• May form part of specific chemotherapy regimens
• e.g. filgrastim

Question 11

What are some complications of neutropenic sepsis? (7)

Answer 11

• Single or multi-organ failure (e.g. renal failure, heart failure and acute respiratory distress syndrome)
• Venous thromboembolism (e.g. pulmonary embolism)
• Disseminated intravascular coagulation
• Opportunistic or hospital-acquired infections
• Delirium
• Psychological complications (e.g. anxiety regarding future infections and chemotherapy treatment)
• Delays in chemotherapy leading to worse cancer outcomes