Management of Post-Meningioma Resection Patient with Leukopenia and Hypothermia
This patient requires immediate active rewarming to achieve normothermia (36-37°C) as the priority, followed by investigation of the underlying cause of leukopenia, which may represent a serious infectious or hematologic complication.
Immediate Temperature Management
The core temperature of 90°F (32.2°C) represents moderate hypothermia requiring urgent intervention 1, 2. This temperature range is associated with significant coagulopathy and increased mortality risk, with each 1°C drop reducing coagulation factor function by 10% 2.
Active Rewarming Protocol for Moderate Hypothermia
Implement Level 2 active rewarming strategies immediately 1:
- Remove any wet clothing and cover with warm blankets 1
- Apply forced-air warming blankets (increases rewarming rate to approximately 2.4°C/hour) 1
- Administer warmed intravenous fluids (not cold fluids, which are contraindicated) 1
- Provide humidified, warmed oxygen 1, 2
- Use heating pads or radiant heaters as adjuncts 1
Monitor core temperature every 5 minutes using esophageal, bladder, or rectal probes (avoid axillary measurements as they read 1.5-1.9°C below actual core temperature) 1.
Rewarming Targets
- Target minimum core temperature of 36°C before considering the patient stable 1, 2
- Stop rewarming at 37°C, as higher temperatures are associated with worse outcomes 1, 2
- Continue monitoring for rewarming complications including arrhythmias, coagulopathy, and hypotension 1, 2
Evaluation of Leukopenia
The white blood cell count of 3,700/μL represents mild leukopenia that requires investigation in this clinical context 1.
Immediate Laboratory Assessment
Obtain the following studies urgently 1:
- Complete blood count with differential to characterize the leukopenia
- Comprehensive metabolic panel
- Cortisol level (hypothermia can be associated with adrenal insufficiency) 1
- Blood cultures if infection is suspected
- Coagulation studies (PT/APTT), as hypothermia impairs coagulation function 3
Differential Diagnosis Considerations
In a patient two years post-meningioma resection, consider:
- Infection (most urgent concern given hypothermia and leukopenia)
- Medication effects or bone marrow suppression
- Recurrent meningioma with hypothalamic involvement causing temperature dysregulation
- Hypopituitarism or adrenal insufficiency from prior surgery
Monitoring During Rewarming
Continuous cardiac monitoring is essential 1:
- Monitor for bradycardia and arrhythmias (bradycardia may be physiologically beneficial during hypothermia) 1
- Watch for rebound hyperthermia, electrolyte abnormalities, and hyperglycemia 1
- Assess for signs of infection or sepsis that may have precipitated the hypothermia
Critical Pitfalls to Avoid
Do not use cold IV fluid boluses - these are only indicated for therapeutic hypothermia, not accidental hypothermia 1.
Do not rely on passive rewarming alone at this temperature - active measures are required for moderate hypothermia 1.
Do not use tympanic or axillary temperature measurements for treatment decisions, as they are unreliable 1, 2.
Handle the patient gently to avoid triggering cardiac arrhythmias 1.
Disposition and Further Management
Once normothermia is achieved and the patient is stable, investigate the underlying cause of both the hypothermia and leukopenia. Consider imaging (MRI brain) to evaluate for meningioma recurrence if no other cause is identified 3. The combination of hypothermia and leukopenia suggests either a serious infection requiring antimicrobial therapy or an endocrine/hypothalamic dysfunction requiring hormonal evaluation and replacement 1.