Neutropenia

Definition

The definition of neutropenia varies from institution to institution and is usually defined as an absolute neutrophil count (ANC) <1.5 x 10⁹/L (<1500 cells/microL) in an adult. Neutropenia is a normal side effect of chemotherapy. Any fever or suspicion of infection should be investigated immediately and managed aggressively.

Pathophysiology

Low numbers of circulating neutrophils reduce the body's ability to fight infection.

Onset/duration

Infections increase in frequency and severity as the Absolute Neutrophil Count (ANC) decreases.

Risk factors

When the nadir persists for more than 7 to 10 days, the risk for severe infection increases.

Grading

*LLN: lower limit of normal
Common Terminology Criteria for Adverse Events (CTCAE) 

Treatment

Full septic workup as per Immediate management of febrile neutropenia document at any signs of fever and/or infection or if the patient becomes unwell following chemotherapy or when neutropenic.

Antibiotics should be commenced as soon as initial blood cultures and swabs have been taken. Do not wait for results to confirm neutropenia or infection as a delay in the commencement of antibiotics can lead to increased morbidity and mortality.

Due to an impaired immune system and/or treatment with steroids, neutropenic patients often do not present with classic signs of infection and should be treated aggressively with intravenous antibiotics and hospitalisation at the first sign of a temperature or being unwell.

Educate patient:

• about neutropenia and risk of infection
• measures to minimise the risk of infection
• to report to the nearest hospital emergency department if the patient develops a temperature equal to or greater than 38°C OR they develop shivers or shakes and or feel unwell
• provide patient with a copy of the Infection during cancer treatment patient information sheet.

Version 3