Fever in neutropenic patient. Oncological emergency

• Consider infection in any unwell patient with neutropenia (neutrophils less than 0.5 × 10^9/L, or less than 1 × 10^9/L with a predicted decline to less than 0.5 × 10^9/L), because fever may not be present, particularly if the patient is elderly or taking corticosteroids.

management

• If suspected in GP or outpatient setting, transfer the patient to hospital urgently.
• Obtain blood culture before administering antibiotics.
  • Adults: two sets of samples (ie four bottles) from separate sites
  • A single, smaller-volume sample is appropriate for young children.
• rapid initiation of broad-spectrum antimicrobials is essential.
  • within 1 hour
  • signs of sepsis or septic shock start antibiotics within 30 minutes.
  • follow local protocols for ABx selection
    • empirical IV Pip-taz (+vanc if septic)
    • if ICU or septic shock: IV gent + vanc + piptaz
• Consider removing intravascular devices—seek expert haematology or oncology advice.