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Definition of Neutropenia
- Neutropenia- Absolute Neutrophil Count (ANC) <1000
- Severe Neutropenia- ANC <500
Note: Some sources have neutropenia starting at 1,500, IDSA says 500
PEARL: Calculating ANC- Total WBC count multiplied by percentage of neutrophils AND percentage of bands
Example: WBC 1,000 x (70% neutrophils + 5% bands): 1,000 x (0.70 + 0.05) =
1,000 x (0.75) = ANC 750
PEARL: Patients may present right prior to their lowest WBC count (nadir). For example- if patient presents 4 days after last chemo with an ANC of 1200, you would expect that they will probably drop lower than 1200 in the next 1-2 days so they may still need admission or close follow-up even though they are not technically neutropenic
Disposition- admit all sick patients but some can be considered for outpatient management with close follow-up
MASCC score
Points given for:
-Mild or no symptoms
-Age less than 60
-No hypotension
-No dehydration
-No history of COPD
-Not currently admitted to the hospital
-Solid organ tumor
-If all negative, may be appropriate for outpatient management with oral antibiotics and close follow-up with the patient’s oncologist
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