This is the first of a two part series on Heme-Onc Emergencies. In this episode, we’ll discuss oncology emergencies to include neutropenic fever, tumor lysis syndrome, malignant spinal cord compression and malignant pericardial effusion. Neutropenic fever is a common chief complaint for patients on chemotherapy so we have to be especially good at this chief complaint.
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Update (10/10/2015)- Someone brought to my attention that some sources have different definitions for neutropenia. Here’s what I found:
Rosen’s/Tintinalli’s- ANC <1000, Severe neutropenia ANC <500
Uptodate: ANC <1,500, Severe Neutropenia ANC <500
IDSA: Neutropenia starts at ANC <500, “Profound” neutropenia ANC <100
Bottom line: Any ANC in the neighborhood of 1,000 to 1,500 is concerning and needs consultation and follow-up with the patient’s oncologist. Also remember that an ANC that is expected to drop below <500 in the next 1-2 days is also concerning (remember that the WBC nadir is usually 5-10 days after last chemo dose).
Also- I forgot to add in the ANC calculation that bands are added to neutrophils (sometimes called “Segs” on a CBC with differential). I fixed it in the show notes.
Here’s the formula:
Absolute Neutrophil Count= (percentage of neutrophils + percentage of bands) x Total WBCs
Example: WBC 1,000, Segs 70%, Bands 5%- (0.7 +0.05) x 1,000 = (0.75) x 1,000 = ANC 750