Febrile Neutropaenia

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Definition

-  Fever >38oC x2 in 1hr in pt w Neutropaenia <1.0x10(9)

 

Features

-  Oncological emergency

-  Usually seen in immunocompromised pts: chemotherapy, Leukaemia..

-  May progress to septic shock

 

Ix

-  FBE: WBC: Neutropaenia <1.0x10(9)

-  CRP: inflammation

-  LFTs, U&E, Coags

-  Septic Workup

-  Blood culture: sepsis

-   If CVC take from line + peripheral

-  Urinalysis: UTI

-  Sputum culture (as relevant): Pneumonia

-  Stool culute (as relevant)

-  CXR: Pneumonia

-  Swabs of lesions or CVC devices

-  +/- LP as indicated

-  Examine any invasive devices: IV canula, PICC etc

-  Avoid PR exam as higher incidence of abscess

 

Mx

-  Empiric Abx after Blood cultures

-  Timentin (Ticarcillin + Clavulanate) 3.1g IV infusion 6/24

-   Penicillin allergy: Meropenem 1g infusion 8/24

-  OR Ceftazadime 2g IV 8/24 OR Tazosin

-  + Gentamicin 5-7mg/kg/day IV infusion

If G+ infection suspected or fever >48hrs + Vancomycin 1g IV infusion 12/24

-  If fever > 5-7/7 wo improvement on above Abx consider antifungal if recommended by ID: Amphotericin B 1mg/kg IV daily

-  Then change to appropriate Abx from Ix

-  +/- G-CSF for prophylaxis ($$$)