Paucis Verbis: Neutropenic fever in cancer patients

ThermometerA 65 y/o man with a history of prostate cancer presents to your ED from home appearing fairly well and a mild cough for 3 days. His vital signs are:

  • Temperature 39 C
  • BP 160/80
  • HR 60
  • RR 14
  • Oxygen saturation 99% on room air

His absolute neutrophil count (ANC) comes back at 300 cells/mm3. His chest xray shows a right middle lobe pneumonia and a central line catheter tip ending in the SVC.

  • Is this patient “high” or “low” risk per the Multinational Association for Supportive Care in Cancer (MASCC)?
  • Does this person require inpatient admission?
  • What antibiotics would you start on this patient?

Answers

  • The patient’s MASCC score is 5 (mild symptoms) + 5 (no hypotension) + 4 (no COPD) + 4 (solid tumor) + 3 (no dehydration) + 3 (outpatient) = 24 = LOW RISK
  • NOTE: “Burden of febrile neutropenia” is a subjective scoring of the patient’s symptoms
  • The patient is, however, ultimately HIGH RISK clinically because of the finding of pneumonia on CXR. Admit.
  • Abx = Cefipime + Vancomycin

FYI: Vancomycin is not always indicated in cancer patients with a neutropenic fever.

PV Card: Neutropenic Fever in Cancer Patients (IDSA 2010)


Adapted from [1]
Go to ALiEM (PV) Cards for more resources.

Thanks to Alissa and Hemal for suggesting the topic!

Reference

  1. Freifeld A, Bow E, Sepkowitz K, et al. Clinical practice guideline for the use of antimicrobial agents in neutropenic patients with cancer: 2010 update by the infectious diseases society of america. Clin Infect Dis. 2011;52(4):e56-93. [PubMed]
By |2021-10-12T15:54:10-07:00Oct 7, 2011|ALiEM Cards, Heme-Oncology, Infectious Disease|

Paucis Verbis card: Supratherapeutic INR

What do you do in these cases?

  • A man on coumadin for atrial fibrillation arrives because he has increased bruising on his skin. He is otherwise asymptomatic. He was told to come to the ED because of a lab result showing INR = 6.
  • A woman on coumadin for atrial fibrillation arrives because of melena and hematemesis. She looks extremely sheet-white pale. Her vital signs are surprising normal. Stat labs show a hematocrit of 15 and an INR value that the lab is “unable to calculate” because it is so high.

Updated on 6/1/13: Old PV card revised to reflect the 2012 ACCP guidelines

(more…)

By |2017-03-05T14:14:35-08:00Jan 15, 2010|ALiEM Cards, Heme-Oncology, Tox & Medications|
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