Saturday, July 28, 2012

Blood Tests are a MUST in Chemotherapy Patient with Fever

Blood Test Required in Chemotherapy Patient with Fever

Cancer patients undergoing chemotherapy in Pennsylvania and across the country must be wary of neutropenic feverNeutropenia is a blood disorder where the body's neutrophils become abnormally low.   Neutrophils usually make up 50-70% of circulating white blood cells and serve as our primary defense against infection by warding off bacteria in the blood.  Though, neutropenia can be caused by a number of conditions, chemotherapy recipients are particularly at risk of developing neutropenia because the medications administered in a typical chemotherapy regimen often suppress good cells like neutrophils while fighting the cancer cells. 

Neutropenia is an extremely serious condition because when a person is neutropenic  the usual signs of infection (redness, swelling and pus formation) are absent.  Fever may be the only sign of a serious infeciton in a neutropenic patient.  Because of this, a fever during chemotherapy must be considered an treated as a medical emergency.

The National Guideline Clearinghouse, has established the current standard for how medical practitioners must respond to a chemotherapy patient presenting with fever.  Keep in mind that this is now the standard practice.  Anything less than what is recommended in this guideline may be medical malpractice.

First, for purposes of responding to a chemotherapy patient with fever,  the guideline defines Fever as a single oral temperature of >38.3° C (101° F); or ≥38.0° C (100.4° F) for ≥1 hour. Neutropenia is defined as an absolute neutrophil count (ANC) <500/mm3 or an ANC that is expected to decrease to <500 cells/mm3 during the next 48 hours.

Second, the guidelines establish that the assessment of risk for complications of severe infection should be undertaken at the mere presentation of fever in a patient undergoing chemotherapy.

Third, the guideline indicates that the initial assessment should include:

1.  Laboratory tests including a complete blood cell (CBC) count with differential leukocyte count and platelet count; measurement of serum levels of creatinine and blood urea nitrogen; and measurement of electrolytes, hepatic transaminase enzymes, and total bilirubin; and

2.  At least 2 sets of blood cultures are recommended, with a set collected simultaneously from each lumen of an existing central venous catheter (CVC), if present, and from a peripheral vein site; 2 blood culture sets from separate venipunctures should be sent if no central catheter is present. Blood culture volumes should be limited to <1% of total blood volume (usually ~70 mL/kg) in patients weighing <40 kg.
Thus, if you or a loved one is underoing chemotherapy and develop a fever, you need to get to a doctor immediately.  Furthermore, if your health care provider responds to your fever with either or a wait and see approach or with only a prescription for oral antibiotics you need to insist that a blood test and culture be undertaken immediately.  While the fever may just be a side effect of the chemotherapy, it could also be a sign of a life threatening infection.  

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