neutropenic sepsis

Question 1

definition of neutropenic sepsis

Answer 1

temp >38 and neutrophil count <0.5x10(9)/L

suspect in all pts who are unwell and within 6wks of recieving chemo

Question 2

Ix for neutropenic sepsis

Answer 2

examine indwelling catheter sites

look for infection - mouth, axillae, perineum, IVI site

take swabs

bloods

• FBC and differential - neutrophils <0.5x10(9)
• plts
• INR
• UE - normal/elevated (renal dysfunction associated with increased neutropenia risk)
• LFT - indicate hepatobiliary infection and RFs - low albumin, high BR and aminotransferases
• LDH
• ​CRP

blood culture x3 - peripherally +- Hickman line

CXR if clinically indicated - pneumonia (can be asymptomatic)

temp >38degrees

Question 3

signs of neutropenic sepsis

Answer 3

localising signs may be absent - because unable to mount an inflammatory response

fever

tachycardia

hypotension

recent chemo

Question 4

aetiology of neutropenic sepsis

Answer 4

DMARDs

chemo

leukaemia

more common in haematological cancer than solid

Question 5

MASCC score

Answer 5

multinational association for supportive care in cancer, assessment tool

predict risk of serious complications in febrile neutropenia

inform Mx - of >21 - risk of septic complications is low and can be avoided

interpret in context of clinical picture

Question 6

causes of neutropenia

Answer 6

viral infections

drugs - post-chemo, cytoytoxic agents, carbimazole, sulfonamides, antithyroid meds, radiation, macrolides, procainamides

severe sepsis

neutrophil Ab - in SLE and haemolytic anaemia - increased destruction

infammation - RA, sjogren’s

hypersplenism (cells become trapped in reticuloendothelium) eg Felty’s syndrome

bone marrow failure - reduced production

transfusion reaction

Question 7

Felty’s syndrome

Answer 7

triad of: RA, low WCC and splenomegaly (+- hypersplenism = anaemia and low plts)

recurrent infections

skin ulcers

lymphadenopathy

95% are Rh factor +ve

Question 8

causes of bone marrow failure

Answer 8

aplastic anaemia

infiltration eg acute leukaemia, myelodysplasia, myeloma, solid tumours, TB

megaloblastic anaemia

myelofibrosis

Question 9

primary acquired causes of neutropenia

Answer 9

leukaemia

lymphoma

aplastic anaemia

Question 10

secondary acquired causes of neutropenia

Answer 10

infection eg salmonella, HIV, Hep A B C

toxic effects - drugs

immune neutropenias

chronic inflammatory disease

nutritional deficiency - B12, folate, copper

Question 11

secondary congenital causes of neutropenia

Answer 11

immunodeficiency syndromes

inborn errors of metabolism

Question 12

acquired autoimmune causes of neutropenia

Answer 12

primary autoimmune neutropenia

neonatal alloimmune neutropenia

Question 13

primary congenital causes of neutropenia

Answer 13

congenital bone marrow failure syndromes

congenital isolated neutropenia syndromes - eg cyclic neutropenia, chronic idiopathic neutropenia

Question 14

epidemiology of neutropenic sepsis

Answer 14

drug induced neutropenia is more common >60yrs nad women

most common life threatening complication of cancer therapy

Question 15

aetiology of neutropenic sepsis

Answer 15

neutropenia = increased susceptibility to bacterial (and less so fungal) infections

Question 16

RF for neutropenic sepsis

Answer 16

• low first-cycle nadir neutrophil count,
• prior history of neutropenic fever,
• prolonged duration of neutropenia,
• magnitude of neutropenia,
• chemotherapy intensity,
• age
• female
• low performance status,
• low albumin level,
• associated anaemia,
• bone marrow involvement,
• pre-existing organ dysfunction

Question 17

pathophysiology for neutropenic sepsis

Answer 17

when pt with neutropenia gets an infection

host endogenous flora is primary source

Escherichia coli, Klebsiella species, and Pseudomonas aeruginosa.

coagulase-negative staphylococci, Staphylococcus aureus, viridans group streptococci, and Enterococcus species.