JAMA ONCOLOGY PATIENT PAGE Febrile Neutropenia Febrile neutropenia is a common complication in patients undergoing anticancer treatments. What Is Neutropenia? What is neutropenia? A neutrophil is a specific type of white blood cell (immune cell) that Neutropenia is when there is a low number of neutrophils in the blood. plays an important role as the body’s first line of defense. The neu- Normal blood cells Neutropenia under the microscope (low neutrophil count) trophils usually make up about half to two-thirds of all white blood Red blood cells and protect against bacterial infections. Patients receiving can- cells Platelet cer chemotherapy (and potentially other) treatments can experi- ence a temporary reduction in their white blood cell counts as a di- rect result of their treatment. In adults, the lower limit of normal neutrophils is 1500 neutrophils per microliter of blood; any num- Neutrophil ber below that is considered neutropenia. Neutropenia grows more severe as the absolute neutrophil count declines from 1500 to 1000 or even below 500. Absolute neutrophil count (ANC) ANC less than 1500 per microliter What Is Febrile Neutropenia? greater than 1500 per microliter of blood Febrile neutropenia refers to the occurrence of a fever during a pe- of blood riod of significant neutropenia. When a patient has neutropenia, his What is febrile neutropenia? or her risk of infection may be higher than normal, and the severity Fever (temperature greater IV antibiotics ofagiveninfectionmaybehigheralso.Infectionscanresultfromtrans- than 100.3ºF) mission of infectious agents between people or as a result of organ- plus isms that live in the mouth, gut, or on the skin but do not normally ANC less than 500 per microliter causeillnessbecausethehealthyimmunesystemkeepsthemincheck. of blood How Is Febrile Neutropenia Managed? Because febrile neutropenia can increase the severity of an infec- tion, patients with this condition should be promptly evaluated by a doctor. Evaluation may include trying to identify a cause of the fe- ver using blood tests, x-rays, or urine studies. It is common for no source of infection to be identified when patients have febrile neu- tropenia. Nevertheless, the cornerstone of management of this con- (short-acting growth factors). Importantly, while these medica- dition is intravenous antibiotics with broad coverage of a wide range tions may reduce the rate of febrile neutropenia, patients can still of infectious sources. Patients are typically hospitalized for this pro- have febrile neutropenia and should report any fevers to their doc- cess to allow close monitoring that usually continues until the pa- tors even if they have received such growth factors. tient’s neutropenia is resolved. Can Febrile Neutropenia Be Prevented? FOR MORE INFORMATION Certain chemotherapy treatments are known to have a higher risk Febrile Neutropenia: Chemotherapy Adverse Effects of febrile neutropenia than others. When these higher-risk treat- http://cancergrace.org/cancer-treatments/2011/05/11/f-n-the-side ments are administered, giving an injection of a medication to help -effect-of-chemotherapy-your-doctor-probably-worries-about-the stimulate the growth of neutrophils might prevent febrile neutro- -most-part-1/ penia or shorten the number of days a patient has neutropenia and Febrile Neutropenia: Prevention and Treatment is thus at risk for febrile neutropenia. These injections are often called http://cancergrace.org/cancer-treatments/2011/05/13/f-and-n-part-i/ growth factors or colony-stimulating factors. They can be given on a one-time basis (long-acting growth factors) or on a daily basis Authors: Krish Patel, MD; Howard (Jack) West, MD The JAMA Oncology Patient Page is a public service of JAMA Oncology.The Published Online: July 27, 2017. doi:10.1001/jamaoncol.2017.1114 information and recommendations appearing on this page are appropriate in most instances, but they are not a substitute for medical diagnosis. For specific information Conflict of Interest Disclosures: None reported. concerning your personal medical condition, JAMA Oncology suggests that you Section Editor: Howard (Jack) West, MD. consult your physician. This page may be photocopied noncommercially by physicians and other health care professionals to share with patients. To purchase bulk reprints, call (312) 464-0776. jamaoncology.com (Reprinted) JAMA Oncology December 2017 Volume 3, Number 12 1751 © 2017 American Medical Association. All rights reserved. Downloaded From: https://jamanetwork.com/ on 09/30/2021.