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Febrile neutropenia

aka neutropenic fever, neutropenic sepsis, febrile neutropaenia, FN rate, neutropenic infection, infection during neutropenia

Fever in a patient whose infection-fighting white cells have been wiped out by chemotherapy. It is a medical emergency: without immune cells, an ordinary infection can become fatal in hours, so antibiotics are started immediately.

Defined as temperature ≥38.3°C (or ≥38.0°C sustained) with neutrophils <0.5 × 10⁹/L, it occurs in 10-20% of patients on many regimens (higher with docetaxel-based, dose-dense and induction chemotherapy), carries 5-10% mortality and is a leading cause of unplanned admission. Management is empirical broad-spectrum antibiotics within an hour, risk-scored (MASCC) to allow oral outpatient treatment for low-risk cases. Prevention with G-CSF (filgrastim, pegfilgrastim) is recommended when a regimen's risk exceeds 20%, and febrile neutropenia is a standard dose-limiting toxicity and reason for dose reduction.

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