Contributor: Taylor Lynch, MD
Educational Pearls:
What is neutropenic fever?
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Specific type of fever that is seen in cancer patients and other patients with impaired immune systems
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These patients are highly susceptible to infection
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Typically occurs 7-10 days after the last chemotherapy dose, this is when the immune system is the weakest
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It is useful to know the specific type of malignancy. For example, heme malignancies (ALL, AML, etc.) have more intense chemo and are at higher risk of neutropenic fever
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To qualify as a neutropenic fever, a patient must have one recorded temperature greater than 38.3 degrees C or be over 38 degrees C for one hour.
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The severity of the neutropenic fever is established by the absolute neutrophil count. Abs neutrophil count under 1500 is mild, less than 1000 is moderate, less than 500 is severe.
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Also look at monocytes (cell that becomes a macrophage). Less than 200 is very concerning
What is the workup and treatment?
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Obtain a panculture (culture blood from both arms and all indwelling lines), obtain urine culture, and get a chest x-ray.
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Do not preform a rectal exam or obtain a rectal core temperature. This could cause bacteremia.
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Treat with Cefepime (broad range and includes pseudomonas but not MRSA). If there is concern for MRSA add vancomycin.
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Admit with Neutropenic precautions (gowns, gloves, mask, positive pressure room)
References
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Peseski, A. M., McClean, M., Green, S. D., Beeler, C., & Konig, H. (2021). Management of fever and neutropenia in the adult patient with acute myeloid leukemia. Expert review of anti-infective therapy, 19(3), 359–378. https://doi.org/10.1080/14787210.2020.1820863
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Zimmer, A. J., & Freifeld, A. G. (2019). Optimal Management of Neutropenic Fever in Patients With Cancer. Journal of oncology practice, 15(1), 19–24. https://doi.org/10.1200/JOP.18.00269
Summarized by Jeffrey Olson, MS3 | Edited by Meg Joyce & Jorge Chalit, OMS3
