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Flashcards in Febrile Neutropenia Deck (35)
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1

When is febrile netropenia most often seen?

As a result of cytotoxic therapy

2

When does the neutrophil count usually reach its lowest level?

5-10 days after the last dose of chemotherapy

3

Other than after cytotoxic therapy, when can neutropenia occur in cancer?

- After radiotherapy
- Part of pancytopenia

4

When can neutropenia follow radiotherapy?

When large volumes of bone marrow are irradiated

5

Why might cancer cause pancytopenia?

Due to malignant infiltration of the marrow

6

What is febrile neutropenia defined as?

- Oral temperature of 38.5 or above, and 2 consecutive readings of 38 or above for 2 hours
- Absolute neutrophil count of 0.5x10^9/L or less

7

When should there be a high index of suspicion for febrile neutropenia?

In all patients who have recently received chemotherapy

8

What is the significance of fever in a cancer patient?

Although there are other causes of fever in a cancer patient, infection should always be assumed unless proven otherwise

9

Are the signs and symptoms of febrile neutropenia significant?

No, they can be minimal

10

When in particular might the signs and symptoms of febrile neutropenia be minimal?

In patients on corticosteroids

11

What should the history include in febrile neutropenia?

- Whether the patient belongs to a high risk group
- Duration since last chemotherapy cycle (if applicable)
- Any recent blood produces
- Any intravascular devices, e.g. cannula, central lines

12

What are the high risk groups for febrile neutropenia?

- Active neoplastic disease
- Recent course of chemotherapy
- Immunosuppressant therapy
- Immunosuppressive illness, e.g. HIV
- CKD

13

What laboratory investigations should be done in febrile neutropenia?

Infection screen comprising of;
- Blood cultures
- MSU
- Chest x-ray
- Swabs for cultures

14

What blood cultures should be done in febrile neutropenia?

- Peripheral
- Central line if present

15

What swabs should be done in febrile neutropenia?

- Throat
- Central line site

16

Are additional microbiological assessments required in febrile neutropenia?

Not unless there are localising signs of infection

17

What is the basic management of febrile neutropenia?

Sepsis 6 bundle

18

What should choice of empirical antibiotics be based on in febrile neutropenia?

Local hospital policies, agreed with microbiologists and based on local antibiotic resistance patterns

19

What is first line empirical antibiotic therapy in febrile neutropenia?

Either monotherapy with tazocin or meropenum, or with the addition of gentamicin

20

What can be added to empirical antibiotic therapy for febrile neutropenia when anaerobic infection is present?

Metronidazole

21

What can be added to empirical antibiotic therapy for febrile neutropenia when gram-positive infection is suspected?

One of;
- Flucloxacillin
- Vancoymycin
- Teicoplanin

22

What should empirical antibiotics be adjusted on the basis of?

Culture results

23

What is the problem with determining suitable antibiotics from culture results in febrile neutropenia?

Cultures are often negative

24

What should be done if there is no response to antibiotics after 36-48 hours in febrile neutropenia?

-Antibiotics should be reviewed with microbiological advice
- Anti-fungal cover should be considered

25

What does recombinant human granulocyte-colony stimulating factor (G-CSF) do?

Stimulates the production of neutrophils in the bone marrow

26

How is G-CSF administered?

SC

27

What is the purpose of G-CSF?

It may reduce the duration of chemotherapy-induced neutropenia, and thereby reduce the incidence of associated sepsis

28

Does G-CSF improve survival?

Currently no evidence that it improves survival

29

Can G-CSF be used prophylactically?

In some cases, but not routinely

30

Give an example of when G-CSF might be used prophylactically in some cases?

Following chemotherapy