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Pediatric Fever And Neutropenia: An Evidence-Based Approach - $30.00
This issue includes 4 AMA PRA Category 1 CreditsTM; 4 ACEP category 1 credits; and 4 AAFP prescribed credits.
Authors Jennifer Sundberg, MD, FAAP Pediatric Fellow in Pediatric Emergency Medicine, The Monroe Carell Jr. Children’s Hospital at Vanderbilt, Nashville, TN Cristina Estrada, MD, FAAP Assistant Professor, Emergency Medicine and Pediatrics, Associate Fellowship Director, Pediatric Emergency Medicine, The Monroe Carell Jr. Children’s Hospital at Vanderbilt, Nashville, TN Thomas J. Abramo, MD, FAAP, FACEP Director, Pediatric Emergency Medicine, Professor, Emergency Medicine and Pediatrics, The Monroe Carell Jr. Children’s Hospital at Vanderbilt, Nashville, TN
Peer Reviewers Nabil M. Ahmed, MD, MPH Assistant Professor, Department of Pediatrics, Baylor College of Medicine, Houston, TX Patricia M. Flynn, MD, MS Department of Infectious Diseases, St. Jude Children’s Research Hospital, Memphis, TN Jerry L. Shenep, MD Department of Infectious Diseases, St. Jude Children’s Research Hospital, Memphis, TN
Published: July 2009; Volume 6, Number 7
Excerpt from this issue...
A resident asks you to review a patient at the end of your shift. The patient, a 4-year-old Caucasian female, has a 2-day history of fever (temperature up to 39.4°C [102.9ºF]), a 3-day history of cough, and symptoms suggestive of a URI. Her triage sheet notes BP, 120/45 mm Hg; HR, 135 bpm; R, 20 bpm; temperature, 38.9°C (102.2ºF); and oxygen saturation of 99% on room air. Upon entering the room, you notice that the girl appears well. The results of her physical examination are normal, with the exception of mildly dry mucous membranes and mild tachycardia. The resident had previously ordered a complete blood cell count that reveals the following values: WBC, 3000/μL; Hb, 13g/dL; Hct, 39%; and Plt, 150,000/μL. The patient’s differential count shows 33% neutrophils, 62% lymphocytes, and 5% monocytes. The resident asks if an absolute neutrophil count of 990 μ/L is normal for a patient of this age. How do you respond?
A complete blood cell count (CBC) is often ordered by emergency department (ED) staff in an effort to better define a disease process or assign risk to a patient’s illness. The ED clinician must be prepared to manage the CBC results even when they are abnormal or not easily explained. One of the most worrisome abnormal findings in children is pediatric neutropenia, defined as an absolute neutrophil count (ANC) less than 1500/μL. Neutropenia can represent an increased risk for invasive disease and have an etiology that is not always readily apparent, especially when accompanied by a fever.
This issue of Pediatric Emergency Medicine Practice focuses on the challenge of evaluating and treating the pediatric patient who presents with a fever and neutropenia. A discussion of chemotherapy-induced neutropenia is included in the Special Circumstances section at the end of the article.
