Neutropenic Fever and Sepsis
Neutropenia is a term used when the neutrophil count in the blood is lower than normal. There are different types of cells in the blood called red blood cells, white blood cells and platelets. The white blood cells can be of many types, one of which are neutrophils. The function of neutrophils is to protect the body against infections.
When drugs such as chemotherapy, biological therapy or immunotherapy are given to the patient, they have an effect on the blood counts causing them to go low. There can be a reduction of the number of neutrophils, platelets and red blood cells. The risk of these cells going low will depend on the type of drugs that are given to treat the cancer.
As the function of the neutrophils is to protect against infection, when the counts go low, the risk of the patient picking up an infection is higher. If the patient picks up an infection at this time, the body has a reduced capacity to fight it and the infection can become serious quickly and the patient can become septic. This condition is called as neutropenic sepsis. If the patient has neutropenia and fever but not sepsis, it is known as a neutropenic fever and this condition is not as serious as sepsis but still needs treatment promptly to stop it turning into a sepsis.
Symptoms of Neutropenic Sepsis
There can be several symptoms associated with neutropenic sepsis and include a raised temperature above 99 degrees, feeling unwell, being more tired than usual, feeling faint, low blood pressure, increased heart rate, fever associated with cough, loose motions etc.
What should the patient do?
If a patient is having cancer treatment, mainly chemotherapy, biological or immunotherapy and has symptoms of fever above 99 degrees or feels very unwell, they should seek the help of their doctor immediately. The doctor usually advises the patient to have an urgent blood test to look for the level of blood cells such as neutrophils. This urgent test should be done immediately and not the next morning or in a few hours. If the blood counts are normal, there is no need for worry, but if they are low, the patient needs admission for antibiotics to be given into the vein. If the patient has neutropenic sepsis, prompt treatment with intravenous antibiotics is very important to prevent the infection turning into a life threatening one.
As stated above, treatment involves giving intravenous antibiotics until the infection settles and the neutrophil counts increase to normal levels. In some patients where the neutropenia is not severe, oral antibiotics can be used on an outpatient basis, and this decision is made by the treating oncologist. Sometimes, treatment may be needed in intensive care unit if the patient is very unwell. Injections called G-CSF to increase the white cell count may also be given depending on the situation. In some patients, these injections may be given with every course of chemotherapy to reduce the risk of neutropenic sepsis.