Board Review

6/12/14 Board (not Bored) review answer!!!

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By Dr. Andrew Grock and Dr. Sally Bogoch

1. Febrile Neutropenia

2. Febrile Neutropenia is defined by having fever…and neutropenia.

2a  fever is one temp >38.3 C (101.3F) or one hour with temp >38C (100.4F).

2b  Neutropenia is defined as an ANC (absolute neutrophil count) < 500 and is calculated by ANC = WBC x (pmn% + band%)

3. Thorough physical exam, sepsis work-up, antibiotics, admission.

3a Abx choices

Ceftazidime +/- aminoglycoside or vanco

Cefepime +/- aminoglycoside or vanco

Imipenem-cliastin

Meropenem

3b Give Vanco if: suspect catheter related infection, hx MRSA, hypotension, + blood cultures for gram pos

3c If outpatient therapy appropriate, can give Augmentin/cipro w/ daily pmd visits x 3 days.

 

References

Rosen’s 8th additional, chapter 123

MDCalc

http://www.mdcalc.com/absolute-neutrophil-count-anc/

Uptodate

http://www.uptodate.com/contents/diagnostic-approach-to-the-adult-presenting-with-neutropenic-fever?source=search_result&search=neutropenic+fever&selectedTitle=2~150#H29410451

 

The views expressed on this blog are the author's own and do not reflect the views of their employer. Please read our full disclaimer here. Any references to clinical cases refer to patients treated at a virtual hospital, Janus General Hospital.
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