GIM Question 21 Instructor

A 65 year old man with known acute myeloid leukemia presents to the emergency department with a temperature of 390C and feeling unwell. A CBC yields a white blood cell count of 0.5×109/L (normal range 4-12×109/L), and an absolute neutrophil count of 0.1×109/L (normal range 2-7×109/L).

  1. What syndrome is this patient exhibiting?
    This patient has febrile neutropenia, which is a medical emergency.
  2. What investigations should be done?
    A full septic workup should be done to determine the source of infection:

    • Labwork: CBC, Lytes, Cr, BUN, AST, ALT, ALP, Bilirubin, Serum lactate
    • Imaging: CXR
    • Urine C&S, urinalysis
    • Blood C&S x2
    • Lumbar puncture for CSF analysis and C&S if meningitis suspected
  3. What therapy should this patient receive?
    Every hospital will have specific antibiotic guidelines for febrile neutropenia, which should be followed. In general, empiric therapy should cover gram +ve and gram –ve bacteria, as well as pseudomonas species.

Freifeld AG et al. Clinical practice guideline for the use of antimicrobial agents in neutropenic patients with cancer: 2010 update by the infectious disease society of America. Clin Infect Dis. 2011, 52:e56-93.

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