Expert Perspectives: Management of Acute Myeloid Leukemia - Episode 9
Yoav Golan, MD, MS, FIDSA, attending physician and associate professor of medicine at Tufts University School of Medicine, Boston, MA, defines febrile neutropenia, or neutropenic fever, and how to manage it in patients with acute myeloid leukemia (AML).
Febrile neutropenia is a common manifestation of infection in patients with acute myeloid leukemia (AML). It is defined as a temperature higher than 38.3 degrees Celsius or 100.5 degrees Farenheit in the presence of any severity of neutropenia, which is typically an absolute neutrophil count (ANC) of less than 1000 cells/mL. In patients with AML, the neutropenia is often below 500 or even 100 cells/mL, says Yoav Golan, MD. Approximately 70-75% of episodes of febrile neutropenia in patients with AML are due to infection, although a specific cause of the fever is not often confirmed in this patient population.
Patients with AML are severely immunocompromised and could be infected by an extensive array of pathogens, including those that can infect anyone regardless of their immune status as well as opportunistic pathogens that only infect individuals who are immunocompromised. Initial evaluation should involve obtaining an accurate patient history, such as if patients have traveled anywhere that might put them at risk for specific bacteria exposure, and any recent procedures. The physical examination should focus on mucosal membranes and the skin in general, notes Golan, cautioning clinicians to be cognizant of any subtle rashes or skin lesions.
Two separate sets of blood cultures should be taken from any patient with neutropenic fever. Other cultures, such as of the urine and sputum, should be drawn based on the patient’s symptoms. Adequate imaging studies that follow the patient’s symptoms and clinical signs should also be performed, states Golan.