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Neutropenic sepsis (Clinical presentation (Fever/shivers, Flu-like…
Neutropenic sepsis
Clinical
presentation
Fever/shivers
Flu-like symptoms
Symptoms of cause
(e.g. sore throat)
Diagnosis
Examination
General
Tachycardia, tachypnea,
pallor, confusion, signs of source
Investigations
Bloods
ABG (metabolic acidosis, lactate), FBC (low WCC, may have pancytopenia), CRP (high), U+E, LFT, clotting, glucose,
blood cultures, viral PCR
Urine
Dipstick (UTI), MCS
Bedside
Obs (tachycardia, tachypnoea, low BP, fever)
ECG (tachycardia)
BM
Imaging
CXR (pneumonia)
USS abdo, CT abdo
CT head
History
DH
Meds e.g. immunosuppressants,
chemotherapy, allergies
FH
Immunosuppression
PMH
Cancer, immune disease,
immunosuppressed
SH
Living arrangements, occupation,
smoking,, alcohol, drugs
PC/HPC
Symptoms, fever
Pathophysiology
Defect
Neutrophils defend against bacteria
and viruses
Depletion reduces immune response
Mechanism
Neutropenia when <1.0x109/L
Usually BM suppression (pancytopenia)
Life threatening infections
Management
Initial ABCDE
Definitive
Conservative
Information, advice, support
Admit, inform senoirs, may need ITU
SEPSIS 6 (ABG, blood cultures, catheterise)
Infection control
Medical
Oxygen
Indication: all patients
E.g. 15L non-rebreathe mask
IV fluids
Indication: shock
E.g. NaCl 0.9% 500mL bolus
Abx
Indication: ASAP
E.g. broad spec per local guidance
G-CSF
Indication: severe neutropenia
MOA: stimulates WCC production
Definition
Disorder of depleted
neutrophils and
superimposed sepsis
Epidemiology
Common in cancer patients
undergoing chemotherapy