From the Guidelines
Febrile neutropenia is diagnosed when a patient has a single oral temperature of ≥ 38.3°C (101°F) or a temperature ≥ 38.0°C (100.4°F) sustained over a 1-hour period and an absolute neutrophil count < 1,000/mL (equivalent to < 1.0 x 10^9/L) 1.
Diagnostic Criteria
The diagnostic criteria for febrile neutropenia include:
- Fever: a single oral temperature of ≥ 38.3°C (101°F) or a temperature ≥ 38.0°C (100.4°F) sustained over a 1-hour period 1
- Neutropenia: an absolute neutrophil count < 1,000/mL (equivalent to < 1.0 x 10^9/L), with severe neutropenia defined as < 500/mL (equivalent to < 0.5 x 10^9/L) and profound neutropenia defined as < 100/mL (equivalent to < 0.1 x 10^9/L) 1
Risk Assessment
Patients with febrile neutropenia can be stratified into high-risk and low-risk categories based on factors such as:
- Duration of neutropenia: anticipated to last ≥ 7 days 1
- Severity of neutropenia: absolute neutrophil count < 100 cells/mm^3 1
- Presence of co-morbid medical problems: such as hemodynamic instability, oral or gastrointestinal mucositis, gastrointestinal symptoms, neurologic or mental-status changes, intravascular catheter infection, new pulmonary infiltrate or hypoxemia, or underlying chronic lung disease 1
- Underlying cancer: such as acute leukemia 1
- Intensity of chemotherapy: such as induction for acute leukemia or HSCT 1
From the Research
Diagnostic Criteria for Febrile Neutropenia
The diagnostic criteria for febrile neutropenia include:
- Fever, defined as a single axillary temperature measurement of ≥37.5°C (oral temperature of ≥38.0°C) 2
- Neutropenia, defined as a neutrophil count of <1000 cells/mm3 2 or an absolute neutrophil count (ANC) of <500 cells/mL 3
- Absolute neutrophil count (ANC) of <1.5 × 10(9)/L is also considered neutropenia 4
Initial Evaluation
Initial evaluation of patients with febrile neutropenia includes:
- A thorough history and physical examination 2
- A complete blood cell count 2, 3, 5
- Measurement of serum creatinine, blood urea nitrogen, transaminases, and C-reactive protein 2
- Culture of blood (samples from a peripheral vein and/or catheter) 2
- Urine culture is indicated in the presence of signs or symptoms of urinary tract infection, a urinary catheter in place, or abnormal results of urinalysis 2
- Chest radiography is indicated for patients with respiratory signs or symptoms 2
Risk Classification
Proper risk classification should be performed using the Multinational Association for Supportive Care in Cancer (MASCC) scoring system to distinguish high-risk and low-risk patients with febrile neutropenia 3