6/12/14 Board (not Bored) review answer!!!

By Dr. Andrew Grock and Dr. Sally Bogoch

1. Febrile Neutropenia

2. Febrile Neutropenia is defined by having fever…and neutropenia.

2a  fever is one temp >38.3 C (101.3F) or one hour with temp >38C (100.4F).

2b  Neutropenia is defined as an ANC (absolute neutrophil count) < 500 and is calculated by ANC = WBC x (pmn% + band%)

3. Thorough physical exam, sepsis work-up, antibiotics, admission.

3a Abx choices

Ceftazidime +/- aminoglycoside or vanco

Cefepime +/- aminoglycoside or vanco

Imipenem-cliastin

Meropenem

3b Give Vanco if: suspect catheter related infection, hx MRSA, hypotension, + blood cultures for gram pos

3c If outpatient therapy appropriate, can give Augmentin/cipro w/ daily pmd visits x 3 days.

References

Rosen’s 8th additional, chapter 123

MDCalc

http://www.mdcalc.com/absolute-neutrophil-count-anc/

Uptodate

http://www.uptodate.com/contents/diagnostic-approach-to-the-adult-presenting-with-neutropenic-fever?source=search_result&search=neutropenic+fever&selectedTitle=2~150#H29410451

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