Neutropenic Sepsis

Question 1

Definition

Answer 1

The development of sepsis in a patient with neutropenia

Question 2

DIagnostic criteria

Answer 2

o Temperature > 38 degrees
o Neutrophil count < 0.5 x 109 /L

CAUTION: patients can have neutropenic sepsis without a fever because they may be on anti-pyretic medications or steroids

Question 3

Aetiology (incidental neutropenia)

Answer 3

o Congenital - ethnic variation, cyclical neutropenia in children (all VERY RARE)

o Acquired
· Decreased/ineffective neutrophil production: bone marrow infiltration, aplastic anaemia, B12/folate deficiency, chemotherapy, radiotherapy
· Accelerated turnover: Felty’s syndrome, hypersplenism, malaria
· Others: toxoplasmosis, dengue fever

Question 4

Aetiology (febrile neutropenia)

Answer 4

DEFINITION: temperature > 38.5 or two consecutive readings of > 38 for two hours and an absolute neutrophil count < 0.5 x 109 /L

Question 5

Epidemiology

Answer 5

Most common in patients with cytotoxic chemotherapy

Question 6

Presenting symptoms (history)

Answer 6

o High-risk features: active cancer, recent chemotherapy, use of immunosuppressants or immunosuppressive illness (e.g. HIV)

o Chronic kidney disease

o Recent blood products

o Intravascular devices (e.g. central line)

Question 7

Signs on physical examination

Answer 7

o Signs of infection may be minimal

o Pyrexia

o Features of infective endocarditis

o Lymphadenopathy

o Skin rashes

Question 8

Investigations

Answer 8

· FBC (check neutrophil level)

· Blood cultures (check for sepsis)

· Others - blood film, D-dimer (for DIC), U&Es, creatinine, LFTs