Usually occurs a few weeks after chemotherapy (14-21 days)
Defined as a fever in the setting of rapidly declining neutrophil count
Patients who report fever at home but who are not febrile in the ED should be treated as if they are neutropenic
ANC=absolute neutrophil count. Calculated by adding neutrophils and bands together
Classification of neutropenia, use the ANC to calculate: Mild: 1000-1500 cells/mm3, Moderate 500-1000 cells/mm3, and Severe Less than 500 cells/mm3.
Mortality rate increases as the ANC drops to below 500 and the duration of neutropenia. These people die of overhwhelming bacterial infections/sepsis.
Treatment: #1 Consider the diagnosis, #2 Broad spectrum antibiotic coverage: Imipenem, or Pip/Tazo, or Cefipime. Consider adding Vanc if the patient has a line, looks ill or is hypotensive, or if the patient has been on a fluoroquinolone.
#1 Pitfall:
Not initiating broad spectrum antibiotic coverage fast enough. These patients can crash very rapidly.
Patients do not have to be febrile in the ED to be diagnosed with this. Their report of fever is enough.
Mortality rates drop the faster big gun antibiotics are given. Don't be skimpy and give Unasyn. Use the big bad boys like single agent Pip/Tazo (4.5 grams, not 3.375), Cefipime, etc. Have a low threshold for adding Vancomycin.
IDSA Guidelines on Neutropenic Fever, 2002. New Guidelines coming Summer 2008!
