What is Neutropenic Fever

Neutropenic fever is a type of fever that can develop when you have a very low number of a certain kind of white blood cells called neutrophils.

This condition is called neutropenia. Neutrophils are made in the spongy tissue inside the bones (bone marrow), and they help the body fight infection.

When you have neutropenia, you could be in danger of a severe infection and neutropenic fever. Neutropenic fever must be treated right away with antibiotic medicines.

What are the causes?

This condition is caused by damage to the bone marrow or damage to neutrophils after they leave the bone marrow. Causes of neutropenia may include:

• Cancer treatments.
• Bone marrow cancer.
• Cancer of the white blood cells (leukemia or myeloma).
• Severe infection.
• Bone marrow failure (aplastic anemia).
• Many types of medicines.
• Conditions that affect the body’s disease-fighting system (autoimmune diseases).
• Genes that are passed from parent to child (inherited).
• Lack (deficiency) of vitamin B.
• Enlarged spleen in rheumatoid arthritis (Felty syndrome).

What are the signs or symptoms?

The main symptom of this condition is fever. Other symptoms include:

• Chills.
• Fatigue.
• Painful mouth ulcers.
• Cough.
• Shortness of breath.
• Swollen glands (lymph nodes).
• Sore throat.
• Sinus and ear infections.
• Gum disease.
• Skin infection.
• Burning and frequent urination.
• Rectal infections.
• Vaginal discharge or itching.
• Body aches.

How is this diagnosed?

You may be diagnosed with neutropenic fever if you have a neutrophil count of less than 500 neutrophils per microliter of blood and a fever of at least 100.4°F (38.0°C). You may have tests, such as:

• Blood tests. These may include:
  • A complete blood count (CBC) and a differential white blood count (WBC).
  • Peripheral smear. This test involves checking a blood sample under a microscope.
• Tests to see whether germs grow from samples of your blood, urine, or other body fluids (cultures). These may be done to check for a source of infection.
• Chest X-rays.

Your health care provider will also determine whether your neutropenic fever is high risk or low risk.

• You may have high-risk neutropenic fever if:
  • Your neutrophil count is less than 100 neutrophils per microliter of blood.
  • You have also been diagnosed with pneumonia or another serious medical problem or infection.
  • Your condition requires you to be treated in the hospital.
  • You are older than 60 years.
• You may have low-risk neutropenic fever if:
  • Your neutrophil count is more than 100 neutrophils per microliter of blood.
  • Your chest X-ray is normal.
  • You do not have an active illness or any other problems that require you to be in the hospital.

How is this treated?

Treatment for this condition may be started as soon as you get diagnosed with neutropenic fever, even if your health care provider is still looking for the source of infection.

• You may have to stop taking any medicine that could be causing neutropenic fever.
• If you have high-risk neutropenic fever, you will receive one or more antibiotics through an IV in the hospital.
• If you have low-risk neutropenic fever, you may be treated at home. Treatment may involve:
  • Taking one or two antibiotics by mouth (orally).
  • Receiving IV antibiotics that are given by a health care provider who visits your home.
• If your health care provider finds a specific cause of infection, you may be switched to antibiotics that work best against those bacteria. If a fungal infection is found, your medicine will be changed to an antifungal medicine.
• If your fever goes away in 3–5 days, you may have to take medicine for about 7 days. If your fever does not go away after 3–5 days, you may have to take medicine for a longer period.
• If your fever is caused by cancer medicines (chemotherapy), you may need to take a certain medicine (white blood cell growth factors) that helps prevent fever.

Follow these instructions at home:

Preventing infection

• Take steps to prevent infections:
  • Avoid contact with sick people.
  • Do not eat uncooked or undercooked meats.
  • Wash all fruits and vegetables before eating.
  • Do not eat or drink unpasteurized dairy products.
  • Get regular dental care, and maintain good dental hygiene.
  • Get a flu shot (influenza vaccine). Ask your health care provider whether you need any other vaccines.
  • Wear gloves when gardening.
  • Wash your hands often with soap and water. If soap and water are not available, use hand sanitizer.

General instructions

• Take over-the-counter and prescription medicines only as told by your health care provider.
• Take your antibiotic medicine as told by your health care provider. Do not stop taking the antibiotic even if you start to feel better.
• Drink enough fluid to keep your urine pale yellow. This helps to prevent dehydration.
• Keep all follow-up visits as told by your health care provider. This is important. If you are being treated with oral antibiotics at home, you may need to return to your health care provider every day to have your CBC checked. You may have to do this until your fever gets better.

Contact a health care provider if:

• You have chills.
• You have a fever.
• You have signs or symptoms of an infection.

Get help right away if:

• You have trouble breathing.
• You have chest pain.
• You feel faint or dizzy.
• You faint.

Summary

• Neutropenic fever is a type of fever that can develop when you have a very low number of white blood cells called neutrophils.
• Neutropenic fever must be treated right away with antibiotic medicines.
• Causes of this condition include cancers of the blood and bone marrow, as well as medicines to treat cancer (chemotherapy).
• Take steps to reduce your risk of infection. These may include avoiding contact with sick people, cooking all meats thoroughly, washing fruits and vegetables before eating, and washing hands often with soap and water.