Neutropenic sepsis

Question 1

Define neutropenic sepsis

Answer 1

Potentially life-threatening complications of neutropenia from any cause-emergency

Defined as any Symptoms of sepsis in a person with a neutrophil count under 0.5

febrile neutropenia is a common complication of chemo/cancer treatment-fever + neutropenia

Question 2

Aetiology and risk factors of neutropenic sepsis

Answer 2

neutropenia means a lowered immune system-infections are more likely, and more likely to progress to sepsis. Also more likely to not get better
Most common causative organisms are bacteria-e.coli, Kleb, pseudomonas aerugionas. staph aureus and strep pneumonia. c diff
Fungi-candida, aspergillosis
Viruses-HSV1/2

Neutropenia can be:
Congenital-rare
Acquired-Cytotoxic cancer therapy
disease of bone marrow-AML, ALL
Infections-EBV, CMV
autoimmune-rare-chrons, RA

risk factors;
Over 60
malignancy
PMHx of neutropenic sepsis
catheters, steroids
prolonged hospital stay

Question 3

Epidiemology of neutropenic sepsis

Answer 3

50 in 1 million-not generally common
but a common complication of cancer treatment and AML/ALL–
deaths are uncommon-300 in 2015, but rising

Question 4

Signs and Sx of neutropenic sepsis

Answer 4

Signs of specific infections
UTI-dysuria, etc
Chest Inf-cough, purulent sputum,etc
Skin
but can also sometimes only have non specific signs of sepsis
Most common-only isolated Fever-need to be careful
In patients with steroids-sometimes nothing

Need to cover PMH and DH very well

examination-see signs related to causative infection
(remember-check for indwelling lines or scars-erythema, pus, warm, oedema)

sepsis signs:
Hypethermia/hypothermia
Tachycardia/tachypnea
Low BP
Low urine output
low GCS
ashen appearance

Question 5

Investigations of neutropenic sepsis

Answer 5

Bedside:
Urine dipstick-for UTI
CBG-blood glucose
ECG

lab:
baseline test-FBC, U&E, LFT (see the neutropenia, signs of AKI)
ABG-Serum lactate-raised, acidosis, any form of resp failure
Blood cultures-2 sets
microbiology swabs

imagine-CXR