Neutropenic Fever, Thrombocytopenia Secondary to Chemotherapy

This patient has developed febrile neutropenia as a consequence of palliative paclitaxel chemotherapy administered 10 days previously. The history and physical suggest herpes zoster infection of the right T-7/8 dermatome. However, a patient with an absolute neutrophil count less than 500 is at high risk for bacterial infection and must be treated emergently with broad-spectrum antibiotics until the leukocyte count recovers. Therefore parental acyclovir and ceftazidime are indicated. Therapy with G-CSF at this time would have little effect on the course of the patient's illness: randomized clinical trials demonstrate that this treatment is not indicated. Studies to date show that the major role for G-CSF is to prevent development of febrile neutropenia in patients receiving chemotherapeutic regimen that has a greater than 40% chance of resulting in febrile neutropenia. Platelet transfusion is restricted to asymptomatic patients with a platelet count <20,000 or thrombocytopenic patients with signs/symptoms of bleeding.

References:

American Society of Clinical Oncology. American Society of Clinical Oncology recommendations for the use of hematopoietic colony stimulating factors: evidence-based clinical practice guidelines. J Clin Oncol 1994; 12:2471-508.

Chanock SJ, Pizzo PA. Fever in the neutropenic host. Infect Dis Clin North Am. 1996; 10: 777-96.

Rabulla P, Sinazzi G, Marangoni F, Avvisati G, Gugliotta L, Tognoni G, et al. The threshold for prophylactic platelet transfusions in adults with acute myeloid leukemia. N Engl J Med 1998; 337:1870-5.