What should be included in a comprehensive medical questionnaire for a patient with neutropenia?

Comprehensive Medical Questionnaire for Patients with Neutropenia

A comprehensive medical questionnaire for neutropenia patients should include assessment of risk factors, symptoms of infection, and specific clinical parameters to guide management and prevent complications. 1

Patient Demographics and Medical History

• Age (patients <60 years have lower risk scores on MASCC index) 1
• Sex
• Ethnicity (constitutional neutropenia more common in patients of African descent) 2
• Primary diagnosis/underlying condition:
  • Cancer type and stage
  • Rheumatoid arthritis or autoimmune disorders
  • Congenital neutropenia disorders
  • History of bone marrow disorders
• Current absolute neutrophil count (ANC) and categorization:
  • Mild (1000-1500 cells/mm³)
  • Moderate (500-1000 cells/mm³)
  • Severe (<500 cells/mm³) 1, 2
• Duration of neutropenia (acute vs. chronic)
• Previous episodes of neutropenia and outcomes

Risk Assessment Parameters

• MASCC risk index score components: 1
  • Disease burden symptoms (absent/mild: 5 points, moderate: 3 points, severe: 0 points)
  • Presence of hypotension (systolic BP >90 mmHg: 5 points)
  • Presence of chronic obstructive pulmonary disease (no COPD: 4 points)
  • Solid tumor or lymphoma without prior fungal infection (4 points)
  • Hydration status (no dehydration: 3 points)
  • Outpatient status at fever onset (3 points)
  • Age <60 years (2 points)
• Expected duration of neutropenia (>7 days indicates high risk) 3, 1

Current Medications and Treatments

• Current chemotherapy regimen and last dose
• Medications that could cause neutropenia:
  • Disease-modifying antirheumatic drugs
  • Antibiotics
  • Antithyroid medications
  • Antipsychotics
  • Anticonvulsants 2
• Current antimicrobial prophylaxis
• G-CSF (filgrastim) usage and dosage
• Other supportive medications

Signs and Symptoms of Infection

General Parameters 3, 1

• Fever (core temperature >38.3°C)
• Hypothermia (core temperature <36°C)
• Heart rate >90 bpm
• Respiratory rate >30 breaths/min
• Mental status changes
• Significant edema or positive fluid balance (>20 ml/kg over 24h)
• Hyperglycemia (>110 mg/dL) in absence of diabetes

Inflammatory Parameters

• C-reactive protein levels
• Procalcitonin levels

Hemodynamic Parameters 3

• Blood pressure (systolic <90 mmHg, mean arterial pressure <70 mmHg)
• Mixed venous oxygen saturation
• Cardiac index

Organ Dysfunction Parameters 3

• Respiratory: PaO2/FiO2 <300, presence of respiratory symptoms
• Renal: Urine output <0.5 ml/kg/h, creatinine increase ≥0.5 mg/dl
• Coagulation: INR >1.5, aPTT >60 seconds
• Gastrointestinal: Presence of ileus, absent bowel sounds
• Hematologic: Platelet count <100,000/μL
• Hepatic: Total bilirubin >4 mg/dL

Tissue Perfusion Parameters 3

• Lactate levels (>3 mmol/L)
• Capillary refill or skin mottling

Specific Infection Sites Assessment

• Oral cavity: Presence of ulcers, mucositis, dental infections 3, 4
• Skin: Lesions, cellulitis, catheter insertion sites 3
• Respiratory tract: Cough, sputum, shortness of breath
• Gastrointestinal: Diarrhea, abdominal pain
• Urinary tract: Dysuria, frequency
• Central nervous system: Headache, neck stiffness
• Perirectal area: Pain, swelling 3

Recent Diagnostic Tests

• Complete blood count with differential
• Renal and liver function tests
• Blood cultures (date and results)
• Other culture results (urine, sputum, wound)
• Radiographic imaging results (chest X-ray, CT scans)
• Bone marrow examination results (if performed) 4
• Genetic testing results (if performed) 5

Infection Prevention Practices

• Hand hygiene compliance 3
• Dietary restrictions followed (neutropenic diet) 3
• Oral hygiene practices 3
• Environmental exposures (plants, flowers, construction) 3
• Recent contact with sick individuals
• Recent travel history

Previous Infections and Complications

• History of febrile neutropenia episodes
• Previous documented infections (type, causative organism)
• Previous hospitalizations for infections
• Previous antibiotic treatments and responses
• History of fungal infections
• History of catheter-related infections

Transfusion History

• Recent blood product transfusions
• Transfusion reactions
• Current hemoglobin and platelet counts 1

Functional Status and Quality of Life

• ECOG performance status
• Ability to perform activities of daily living
• Impact of neutropenia on quality of life
• Presence of fatigue, weakness

Special Considerations

• For females: Menstrual status, pregnancy status 5
• For pediatric patients: Growth and development status
• For elderly patients: Comorbidities that may increase infection risk

Follow-up Plan

• Frequency of blood count monitoring
• Threshold for seeking medical attention (temperature >38.3°C)
• Emergency contact information
• Home care instructions

This comprehensive questionnaire provides a structured approach to evaluating patients with neutropenia, focusing on risk stratification, early detection of infections, and appropriate management strategies to reduce morbidity and mortality. The MASCC risk index should be calculated for all patients to guide the intensity of monitoring and interventions 1.