Febrile Neutropenia

Febrile neutropenia occurs when a patient has a fever and a significant reduction in their white blood cells (neutropenia) that are needed to fight infections.

Patient information on neutropenia

Introduction

Febrile neutropenia occurs when a patient has a fever and a significant reduction in a type of white blood cells, known as neutrophils, which are needed to fight infections. Many patients, when undergoing cancer treatment, will experience a reduction in their white blood cells, which may be temporary or may persist for some time. Patients with febrile neutropenia require the timely assessment and treatment of their condition, to identify the possible sources of infection and to cure the infection.

The diagnosis of febrile neutropenia is confirmed by assessing the patient's temperature and white blood cell count through blood tests. Once the diagnosis of febrile neutropenia is confirmed, then further investigations such as cultures are done to determine the presence of infection and its possible sources. Based on the patient's clinical status, the physician will determine if the patient should be admitted to a health care facility for observation and treatment or if the patient can be treated at home. The treatment of febrile neutropenia consists of antimicrobial agents, with the goal of curing any possible sources of infection.

Leukemia & bone marrow transplant

October 2016

Should a patient undergoing treatment for acute leukemia or stem cell transplantation present in the emergency room for fever, please assess the patient, proceed with the following investigations and initiate broad spectrum intravenous antibiotic coverage immediately. Please inform the on-call BMT physician. The on-call physician can be reached 24 hours a day by calling Vancouver General Hospital locating at 604-875-5000 or the Vancouver General Hospital’s inpatient ward at 604-875-4343.

Investigations:

Complete physical examination, including vital signs
CBC (including differential and platelet count)
Electrolytes, urea, creatinine and liver function tests
Serum lactate
Blood and urine cultures
Chest X-ray, oxygen saturation

Antibiotics:

Please refer to the Vancouver Coastal Health’s Febrile Neutropenia pre-printed order forms:

Patients must be admitted if they are hemodynamically unstable and/or unable to tolerate oral hydration. The differential diagnosis for fever in this patient population is broad and includes bacterial, fungal and viral infections.

For more information, please contact Dr. Raewyn Broady at the Leukemia/ BMT Program of Vancouver Coastal Health at 604-875-4863.

Pediatric

Updated April 2012

Fever associated with neutropenia (<1.0 x 109/L) is an emergency! These patients can rapidly develop septic shock associated with a high mortality rate.

For management guidelines for fever and neutropenia, please see Empiric Antibiotic Protocol for Fever and Neutropenia.

Solid tumour or lymphoma

Updated December 2022

Febrile neutropenia assessment and treatment guidance

Febrile neutropenia assessment and treatment protocol

Disclaimer

Both the format and content of the guidelines will change as they are reviewed and revised on a periodic basis. Any physician using these guidelines to provide treatment for patients will be solely responsible for verifying the doses, providing the prescriptions and administering the medications described in the guidelines according to acceptable standards of care.