From the Research
Management of leukocytopenia following EUS cystgastrostomy requires prompt intervention with close monitoring of white blood cell counts and infection surveillance, and the use of granulocyte colony-stimulating factor (G-CSF) such as filgrastim is highly associated with treatment of severe neutropenia, as shown in a study published in the Asian Pacific journal of cancer prevention 1. The first step is to determine the severity of leukocytopenia, with counts below 1,000/μL requiring more aggressive management.
- Daily complete blood counts should be ordered to track trends.
- For mild to moderate cases (WBC 1,000-3,000/μL), consider G-CSF such as filgrastim at 5-10 μg/kg subcutaneously daily until counts recover above 3,000/μL, as this has been shown to reduce the severity of neutropenia in solid cancer patients 1.
- Prophylactic antibiotics may be warranted, typically with fluoroquinolones like levofloxacin 500 mg daily or ciprofloxacin 500 mg twice daily.
- Maintain strict infection control measures including isolation if counts are severely low.
- Nutritional support is important, ensuring adequate protein intake of 1.2-1.5 g/kg/day.
- Avoid medications that may further suppress bone marrow function, including certain antibiotics and anticonvulsants. The leukocytopenia is likely related to inflammatory response, procedural stress, or medication effects from anesthesia or antibiotics used during the procedure.
- If leukocytopenia persists beyond 7-10 days or worsens despite treatment, hematology consultation is recommended to evaluate for other underlying causes. It is also important to note that the use of filgrastim has been shown to accelerate recovery from infection associated with chemotherapy-induced neutropenia, and to reduce the duration of febrile neutropenia 2. However, the most recent and highest quality study on this topic is from 2009, which highlights the importance of filgrastim in the treatment of severe neutropenia 1.