Curriculum · Hematology
Febrile neutropenia
What it is
Febrile neutropenia is fever in a neutropenic patient. Fever counts either as a single reading of 38.3°C or more, or as a reading of 38.0°C or more held for more than 1 hour. Neutropenia is an ANC under 1500 cells/uL, and it is severe when the ANC is under 500, or is expected to fall below 500 in 48h.
Causes and risk
The neutropenia is most often chemotherapy-induced marrow suppression. The other causes listed are hematologic malignancies, leukemia among them, and bone marrow failure syndromes.
Risk is then stratified:
- Low risk: neutropenia expected to last under 7 days, no comorbidities
- High risk: prolonged neutropenia over 7 days, unstable vitals, or organ dysfunction
The organisms follow the same pattern each time. Gram-negative bacteria such as Pseudomonas and E. coli carry a high risk of sepsis. Gram-positive Staph and Strep are common, especially with catheters, and gram positive cocci in chains on blood culture point to Streptococcus viridans or Enterococcus faecalis. Fungi, Candida and Aspergillus, appear if the neutropenia is prolonged.