Leukaemia update. Part 2: managing patients with leukaemia in the community

In the review on the management of patients with leukemia by Grigoropoulos and colleagues, impetus is given to the early and appropriate management of patients with neutropenic sepsis. In this context, certain practical issues may be considered. Firstly, fever in a neutropenic patient does not always mean an underlying infection. Other causes include drug fever, blood transfusions and the underlying leukemia itself. One of the commonest agents used in acute leukaemia treatment, cytarabine is well-known to cause fever. Another overlooked diagnosis is that of interstitial pneumonitis, which can again be caused by drugs. This condition can present with fever and respiratory symptoms in a neutropenic patient and may need treatment with corticosteroids which are contra-indicated in septic patients.

On the contrary, neutropenic sepsis can present without fever. Often acute lymphoblastic leukemia patients receive steroids which masks the signs of infection, including a high temperature. In these cases, the vital signs of tachycardia and tachypnoea can suggest an underlying infection. These patients would need urgent medical attention as much as those with neutropenic pyrexia.