Febrile neutropenia is a single temperature of 38.3°C, or 38.0°C sustained over an hour, in a patient with an absolute neutrophil count below 0.5 × 10⁹/L or expected to fall below it. It is not a diagnosis to be confirmed before treatment. The target is antibiotics within one hour of presentation, and everything else — imaging, source hunting, the second set of cultures — happens around that, not before it.
The practical failures are predictable. The patient presents to a general emergency department where the chemotherapy history is not asked for and the count is not known. The blood cultures are taken from the peripheral vein only, when the line is the likeliest source and paired central and peripheral cultures are what identify it. Or the antibiotic waits for the full blood count because nobody was willing to commit without the number.
Give every patient starting chemotherapy a written card stating their regimen, their centre's contact number and the words 'a temperature of 38 degrees is an emergency'. And treat absence of fever as uninformative: a neutropenic patient on steroids may have overwhelming sepsis and a normal temperature, so hypotension, rigors, confusion or simply looking unwell in a neutropenic patient warrants the same pathway.
- Antibiotics within one hour — do not wait for the count, the imaging or the source
- Take paired central and peripheral cultures when a line is in place
- Give every chemotherapy patient a card with their regimen and an emergency number
- Steroids mask fever; treat the unwell neutropenic patient regardless of temperature
- Record the day of the cycle — the nadir timing tells you how likely neutropenia is before the count returns
Why it matters
Most delays in febrile neutropenia come from waiting for confirmation that the definition does not require.
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