Haematology & Oncology

Neutropenic Sepsis

Anticancer treatment removes the neutrophils that both contain infection and generate its localising signs, so bacteraemia can progress to shock in a patient who still looks well.

Definition

NICE diagnoses neutropenic sepsis when a patient having anticancer treatment has a neutrophil count of 0.5 × 10^9/L or lower. They must also have a temperature above 38°C, or other signs or symptoms consistent with clinically significant sepsis.

First principles

No neutrophils means no pus, no consolidation and no reliable warning

Neutrophils produce the localising signs clinicians rely on. Without them a chest infection may give no crackles and a line infection no erythema. The UK Oncology Nursing Society (UKONS) states that neutropenic patients with early bacterial infection cannot be reliably distinguished from non-infected patients at presentation. A patient who looks well on arrival can progress to septic shock within hours.

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