Neutropenic Sepsis

Exam Cram

• Neutrophils are an integral part of the immune's response to bacterial infections

• Infection + low neutrophils (neutropenia) can result in sepsis and death

• Causes: cancer or cancer treatments

• Diagnosis: < 0.5 neutropenia + signs of infection

• Management: Tazocin TDS IV, filgrastin

Med Reg Notes

Filgrastrin

Filgrastrin: G-CSF receptor analogue, stimulates production of neutrophils from bone marrow. 

Common ward scenario of chasing bloods of someone on filgrastim can have an enormous WCC rise to 40. This is an appropriate response to the filgrastin. 

Asymptomatic neutropenia

Due to risk of neutropenic sepsis in those with neutrophils < 0.5; filgrastin is given for 7d or until neutrophils > 1.0 on consecutive days. 

Immunocompromised Sepsis

On admission to hospital, individuals are often covered for 'neutropenic sepsis' without being neutropenic. I prefer the categorisation below, using 'immunocompromised' if their neutrophils and lymphocytes are normal. 

Immunocompromised Sepsis

Deficient immune system due to :

• Age: very young or very old

• Medications- steroids, DMARDs, chemotherapy

• Infections: HIV

• PMH: cancers (particularly leukaemia, lymphomas)

Neutropenic Sepsis

• Neutrophils < 0.5

• Chemotherapy within the last two weeks (regardless of neutrophils)

Lymphopenic Sepsis

• Risk of Pneumocystis jiroveci pneumonia

• Acute lymphopenia often caused by viral infection

Page written in 2024.