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<< Pediatric Fever And Neutropenia: An Evidence-Based Approach
Emergency Department Evaluation
In cases of suspected pediatric neutropenia, insight into the etiology and course of the underlying illness may be gained from the patient’s history and physical examination. It is important to determine if the disorder is acute, chronic, or recurrent. Does the child have recurrent fevers, repeated infections, frequent aphthous ulcers, or a history of neutropenia? Is there a family history of neutropenia or blood disorders? Does the child have a previously diagnosed condition such as a metabolic disorder or malignancy? Does the patient have associated symptoms suggestive of a viral etiology? Does the patient take any medications?
During the examination, the patient’s vital signs should be scrutinized. Is the patient toxic appearing? Does the patient have any obvious congenital anomalies? Is there evidence of malnourishment, short stature, or skeletal anomalies? Careful observation for a source of infection is crucial, with close attention paid to skin, oral mucosa, and the perirectal region. It is important to note, however, that typical signs of infection such as exudate, fluctuance, or purulent drainage may be absent in the neutropenic host.9,46 Except in profound neutropenia and immunosuppression,signs of infection such as erythema, pain, and warmth are generally preserved.10 The clinician should palpate the patient’s lymph nodes and assess for hepatosplenomegaly. Lack of bruising and petechiae should be documented, as this is crucial in helping to rule out an underlying leukemic process. Abnormal skin coloring, dystrophic nails, albinism, fine hair, and severe eczema should also be noted.8 The emergency clinician should be able to risk stratify based on the patient’s history and physical examination and concurrent laboratory findings.
During the examination, the patient’s vital signs should be scrutinized. Is the patient toxic appearing? Does the patient have any obvious congenital anomalies? Is there evidence of malnourishment, short stature, or skeletal anomalies? Careful observation for a source of infection is crucial, with close attention paid to skin, oral mucosa, and the perirectal region. It is important to note, however, that typical signs of infection such as exudate, fluctuance, or purulent drainage may be absent in the neutropenic host.9,46 Except in profound neutropenia and immunosuppression,signs of infection such as erythema, pain, and warmth are generally preserved.10 The clinician should palpate the patient’s lymph nodes and assess for hepatosplenomegaly. Lack of bruising and petechiae should be documented, as this is crucial in helping to rule out an underlying leukemic process. Abnormal skin coloring, dystrophic nails, albinism, fine hair, and severe eczema should also be noted.8 The emergency clinician should be able to risk stratify based on the patient’s history and physical examination and concurrent laboratory findings.
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