Answer: Febrile
neutropenia.
The word febrile means
you have a fever. A fever is defined as
a single oral temperature of greater than or equal to 38.3°C (101 F), or a
temperature of greater than 38.0°C (101.4 F) lasting at least an hour. NOTE: Patient may not present
with fever, but may have symptoms such as hypotension, tachycardia or chills. Fever neutropenia occurs when a patient has a fever and a
significant reduction in their white blood cells (neutropenia) that are needed
to fight infections. Many patients when undergoing cancer treatment will have a
reduction in their white blood cells that may be temporary or may persist for
some time. The fever may be caused by an infectious agent, and when it is rapid
treatment is required. A patient with febrile neutropenia needs assessment for
the possible source and type of infection and treatment until the cause is
found or it subsides.
What
you should do if you have any of these signs?
Sometimes it is hard
to tell if you have an infection. However, if you have any warning signs and
your white blood cells count may be low, this is a medical emergency.
Even if you feel fairly well, you must contact your doctor or nurse or go to
your nearest hospital Emergency Room immediately!
What could happen if the physician
confirms that you have a febrile neutropenia?
The first decision of the
physician will be to hold the chemotherapy treatment. If the patient has
febrile neutropenia then cultures and more blood tests will be taken to try to
determine the presence and possible site of any infections. A decision will
have to be made by the physician as to whether the patient should be admitted
to a health care facility for observation and treatment. This decision will be
based on the clinical state of the patient and the predicted length of the
lowered white blood cell counts. Whether the patient is admitted or not
treatment will usually include the use of antibiotics. Be aware that you
physician may prescribe you the colony-stimulating factors (CSFs), which are glycoproteins
that stimulate a fast repopulation of the white blood cells, for a faster
control of the infection or febrile neutropenia .
What are the risks to develop a febrile neutropenia?
In addition to the risk of
the chemotherapy treatment and the specific malignancy being treated, the
following factors need to be considered when evaluating a patient’s overall
risk for febrile neutropenia: Older patient, previous chemotherapy and
radiotherapy, preexisting neutropenia or bone marrow dysfunction due to tumor
involvement, poor performance status and poor renal and liver function. If you are in one of such group of risk, your
physician will recommend the use of CSF prophylactically in each cycle of
treatment.
Luis Mendoza, MD, PHD
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