Practice Easily Missed?

Febrile neutropenia

BMJ 2010; 341 doi: http://dx.doi.org/10.1136/bmj.c6981 (Published 17 December 2010) Cite this as: BMJ 2010;341:c6981
  1. Jay D Naik, academic clinical lecturer in medical oncology1,
  2. Suren R K Sathiyaseelan, general practitioner2,
  3. Naveen S Vasudev, academic clinical lecturer in medical oncology1
  1. 1St James’s Institute of Medical Oncology, St James’s University Hospital, Leeds LS9 7TF, UK
  2. 2The Surgery at Nursery Lane and Adel, Leeds LS17 7AQ
  1. Correspondence to: N S Vasudev n.vasudev{at}leeds.ac.uk
  • Accepted 9 September 2010

The definition of febrile neutropenia varies but is generally regarded as the presence of a fever >38°C with an absolute neutrophil count of <1.0×109/L. Febrile neutropenia is a result of bone marrow suppression, a common side effect of chemotherapy. Patients with neutropenia are susceptible to developing life threatening bacterial infection. Infection should also be considered in any systemically unwell patient receiving chemotherapy, even if no fever is present.

Case scenario

A 33 year old man presented to his local district hospital a week after chemotherapy, stating that he had a moist cough, with a fever of 38.8 at home. As he had no fever and appeared well on examination, with no abnormal chest findings, he was prescribed amoxicillin and discharged. Over the next 24 hours he became increasingly unwell and presented at the emergency department with septic shock and severe neutropenia (neutrophils 0.02×109/L). Despite fluids and broad spectrum antibiotics, the patient died.

How common is febrile neutropenia?

  • The risk of febrile neutropenia varies widely (5%-50%) depending on the chemotherapy regimen1 2 3

  • The number of patients receiving chemotherapy each year in England is increasing4

  • An estimated 65 000 chemotherapy programmes (a planned period of repeated cycles of treatment) are delivered annually in England.4 On the basis of this figure, we conservatively estimate that at least 10 000 episodes of febrile neutropenia occur annually

  • Risk increases with age (65 years and over), advanced stage of disease, presence of comorbidities, haematological malignancy, and absence of haematopoietic colony-stimulating factors support, and if a patient has had a …

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