febrile%20neutropenia
FEBRILE NEUTROPENIA
Treatment Guideline Chart
Febrile neutropenia is having a fever of ≥38.3 ºC or ≥38 ºC over an hour and neutropenia that is having an absolute neutrophil count (ANC) of <500 neutrophils/mm3 or an ANC <1000 neutrophils/mm3 expected to decline to ≤500 neutrophils/mm3 over the next 48 hours.
The risk of febrile neutropenia is directly proportional to the duration and severity of neutropenia.
Fever is frequently the only indication of infection in the neutropenic patient.

Febrile%20neutropenia Signs and Symptoms

Definition

Fever
  • Defined as single oral temperature ≥38.3°C (101°F) or 2 consecutive readings ≥38.2°C (100.4°F) over 1-2 hours
Neutropenia
  • Defined as an absolute neutrophil count (ANC) of ≤500/μL (<0.5 x 109/L) or an ANC ≤1000/μL expected to decline to ≤500/μL (<0.5 x 109/L) over the next 48 hours
  • Severe neutropenia is defined as ANC <500/μL (<0.5 x 109/L)
  • Profound neutropenia is defined as ANC <100/μL (<0.1 x 109/L)
  • ANC is calculated by multiplying the total white blood cell count by the percentage of polymorphonuclear cells (PMNs) and band neutrophils

The risk of febrile neutropenia is directly proportional to the duration and severity of neutropenia

Epidemiology

  • Source of infection is identified in 20-30% of episodes with febrile neutropenia
    • Bacteria are the most common cause of infection
    • Fungal infections are common in high-risk patients with febrile neutropenia

Pathophysiology

  • Factors contributing to febrile neutropenia include:
    • Direct effect of chemotherapy or immunosuppressive therapy on the immune system and on mucosal barriers
    • Immunodeficiencies associated with primary malignancy
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