Neutropenic fever
Formal Definition
A medical emergency defined as a single oral temperature ≥38.3°C (101°F) or ≥38.0°C (100.4°F) sustained over one hour in a patient with an absolute neutrophil count (ANC) <500 cells/mcL, or expected to fall below 500; presumed to represent bacterial infection until proven otherwise, requiring emergent broad-spectrum antibiotics.
How It's Used on the Ward
"Neutropenic fever" or "febrile neutropenia" — the oncologic emergency that triggers the automatic antibiotic protocol in cancer patients on chemo.
Example
""Day 10 post-CHOP in a lymphoma patient, calls with temperature 38.5: ANC 180. This is neutropenic fever. Go to the ED immediately, cultures drawn, cefepime 2g IV within 60 minutes, and admission for monitoring. Do not wait for culture results.""
Clinical Context
ANC = WBC x % neutrophils. ANC <500 = severe neutropenia. ANC <100 = profound neutropenia (highest risk). Empiric regimen: antipseudomonal beta-lactam (cefepime, pip-tazo, or carbapenem). Add vancomycin for: suspected catheter infection, skin/soft tissue infection, hemodynamic instability, known MRSA colonization. MASCC score risk-stratifies: high-risk (hospitalized, MASCC <21) vs low-risk (MASCC ≥21, early discharge with oral fluoroquinolone possible). G-CSF (filgrastim) shortens neutropenic duration. Mortality from untreated gram-negative sepsis in neutropenic patients can be >50% within hours.
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