oncologic emergencies

Fever and Neutropenia (FN) (NCCN Guidelines v.1.2019)

Definition

  • Fever: single oral temp ≥38.3°C (101°F) or ≥38°C (100.4°F) for ≥1 h
  • Neutropenia: ANC <500 cells/µL or <1000 cells/µL with predicted nadir <500 cells/µL

Pathophysiology and microbiology

  • Predisposing factors: catheters, skin breakdown, GI mucositis, obstruction (lymphatics, biliary tract, GI, urinary tract), immune defect associated with malignancy
  • Most episodes thought to result from seeding of bloodstream by GI flora
  • Neutropenic enterocolitis (typhlitis): RLQ pain, watery/bloody diarrhea, cecal wall thickening
  • GNRs (esp. P. aeruginosa) were historically most common
  • Gram ⊕ infections have recently more common (60–70% of identified organisms)