Clinical Case Database / Category: Patient Management
Management of the febrile neutropaenic patient
Publication details
James A. Richards BSc, MRCP
Foundation Years Journal, volume 4, issue 4, p.30 (123Doc Education, London, April 2010)
Abstract
Mrs S is a 44-year-old lady who has been brought in by ambulance to the A&E of her local district general hospital, accompanied by her husband. He contacted their GP when she began feeling unwell early that morning, with rigors and a temperature of 39°C (recorded at home); her GP advised that she come directly to hospital. She is on a long course of chemotherapy for acute myeloid leukaemia (AML) and was discharged from hospital 1 week ago. On arrival in the A&E, Mrs S is flushed and looks unwell. Her initial observations are as follows: pulse 98 beats per minute; BP 95/60; respiratory rate 24; oxygen saturations 95%; and temperature 38.5°C. A urine dipstick revealed a trace of protein and ketones , but no nitrites or leucocytes. Chest X-ray is unremarkable, other than Mrs S's Hickman line in her right subclavian vein. She is commenced on intravenous fluids and given paracetamol for her temperature. You are the FY1 doctor on-call and you are asked to clerk the patient for admission, prior to assessment by the haematology SpR, who is on-call from home; and will be in the hospital in around 45 minutes.
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Authors
James A. Richards BSc, MRCP
ST3 in Geriatrics
Southampton General Hospital
jamesonrichards@doctors.org
References
1. Hoffbrand V, Moss P, Pettit J (2006) Essential Haematology. Wiley-Blackwell.
2. Godwin JE, Braden C. eMedicine: Neutropaenia: http://emedicine.medscape.com/article/204821.
3. Dellinger RP et al. (2004) Surviving Sepsis Campaign guidelines for the management of severe sepsis and septic shock. Critical Care Medicine, 32(3):260–264.
4. American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference: definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. Critical Care Medicine 20(6):864–874.
5. Williams AJ (1998) Assessing and interpreting arterial blood gases and acid-base balance. British Medical Journal, 317:1213–1216.
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The Foundation Years Clinical Cases Database is a selection of 600 peer-reviewed clinical cases in the field of patient safety and clinical practice, specifically focused on the clinical information needs of junior doctors, based around the Foundation Year Curriculum programme (MMC). The cases have been chosen to align with the Foundation Year Curriculum.
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