UMEM Educational Pearls

Category: Misc

Title: Neutropenic Fever-Pearls and Pitfalls

Keywords: Fever (PubMed Search)

Posted: 3/31/2008 by Rob Rogers, MD (Updated: 12/14/2019)
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Neutropenic Fever

A few pearls about neutropenic fever:

  • 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!