• Neutropenic Fever

    (Febrile Neutropenia)

    Definition

    A neutropenic fever is a temperature over 100.4°F (38°C) in a person with neutropenia. Neutropenia is a descriptive term referring to having a low number of neutrophils in the blood. A neutrophil is a type of white blood cell that helps to fight bacterial infections. As a result, when the neutrophil counts are low, the body is much more susceptible to infections.
    Medical care is important at the first sign of fever to best manage the cause of the fever and decrease the risk of serious complications.
    White Blood Cells
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    Causes

    The fever is usually caused by an infection.
    The body needs a specific range of neutrophils help to prevent and fight infections in the body. When the number of white blood cells in the body drops below normal levels, the body is less able to stop infections from developing or fight infections that have started. Early treatment of neutropenic fever is important to help the body fight the infection before complications develop. The reduction of neutrophils can have a number of causes, including viral infections or side effects to certain medications. It is most commonly associated with cancer or cancer treatments.

    Risk Factors

    Having neutropenia increases the chance of infection. The lower the neutrophil count and the longer it is present, the higher the risk. Other factors that may increase the chance of neutropenic fever include:
    • Increasing age
    • Uncontrolled cancer
    • Chronic obstructive pulmonary disease (COPD)
    • Liver or kidney problems

    Symptoms

    • The hallmark symptom of neutropenic fever is a body temperature over 100.4°F (38°C). In some cases, it may be the only symptom.
      Other symptoms of fever include:
      • Chills
      • Sweating
    The infection may cause other symptoms depending on location and severity of infection. For example, a urinary tract infection may cause a burning sensation during urination, an infection in the lungs may cause a painful cough.

    Diagnosis

    You will be asked about your symptoms and medical history. A fever can be diagnosed by taking your temperature. If you have not been diagnosed with neutropenia, but your doctor suspects it based on your medical history, a blood test will be done for confirmation. Neutrophils are measured as part of a blood test called a CBC (complete blood count) that measures both red and white blood cell counts in the blood.
    One or more of the following tests will help identify the specific cause of the infection:
    • Blood tests and culture
    • Urine tests and culture
    • Cultures to test other suspicious tissue
    • Sputum samples
    • Stool samples
    • Lumbar puncture—evaluates the cerebrospinal fluid that protects the brain and spinal cord
    • Biopsy—tissue samples are examined under a microscope
    • X-rays of areas suspected as the infection source, such as the lungs or sinuses

    Treatment

    Treatment is started immediately. If the infection is not treated right away, life-threatening complications may occur.
    Neutropenic fever is most often treated with antibiotics that are known to fight a wide range of infections. Other medications may be used if another type of infection is suspected. For example, your doctor may suspect a fungal infection based on your history.
    Tests to identify specific infectious agents can take a few days to complete. Your medication may be changed based on the test results to best treat the infection.

    Prevention

    Some with neutropenia have a high risk for developing infection. Preventive antibiotics may be prescribed to help stop infections before they develop.
    Other steps include general infection precautions, such as:
    • Practicing good hand washing techniques.
    • Avoiding contact with people who are sick.
    • Keeping flu and pneumonia vaccines up to date.

    RESOURCES

    American Cancer Society http://www.cancer.org

    National Heart, Lung, and Blood Institute http://www.nhlbi.nih.gov

    CANADIAN RESOURCES

    Canadian Cancer Society http://www.cancer.ca

    Public Health Agency of Canada http://www.phac-aspc.gc.ca

    References

    Book L. Neutropenic fever following chemotherapy in a patient with lymphoma. Oncol Nurs Forum. 2008;35(6):885-887.

    Febrile neutropenia. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated June 2, 2016. Accessed June 6, 2016.

    Freifeld AG, Bow EJ, Sepkowitz KA, et al. Clinical practice guideline for the use of antimicrobial agents in neutropenic patients with cancer: 2010 Update by the Infectious Diseases Society of America. Clin Infect Dis. 2011;52(4):427-431.

    Infections in people with cancer. American Cancer Society website. Available at: http://www.cancer.org/acs/groups/cid/documents/webcontent/002871-pdf.pdf. Accessed June 6, 2016.

    Revision Information

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