What are the ASCO/IDSA guidelines for the initial assessment of neutropenic cancer patients?

Updated: Sep 16, 2018
  • Author: Alexandre Chan, PharmD, MPH, FCCP, BCPS (AQ-ID), BCOP; more...
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Answer

Answer

Recommended tests and procedures for the initial assessment (consensus based; evidence quality: low; strength of recommendation: moderate) include the following:

  • Complete blood cell count (CBC) with differential, hemoglobin, and platelet count;
  • Serum creatinine and blood urea nitrogen (BUN)
  • Electrolyte levels
  • Serum lactate
  • Liver function tests (total bilirubin, alkaline phosphatase, transaminases)
  • At least two sets of blood cultures, with samples taken from different sites 
  • Cultures from suspected infection sites (eg, urine, lower respiratory tract, CSF, stool, wounds)
  • Chest imaging study for patients with clinical manifestations of lower respiratory tract infection
  • Patients with a flulike illness in the setting of seasonal community-acquired respiratory illnesses should have a nasopharyngeal swab obtained for detection of influenza. In some of these cases (eg, patients with hematologic malignancy and hematopoietic stem cell transplantation [HSCT], strong consideration should be given to obtaining expanded viral panels for detection of additional respiratory viruses: influenza virus, parainfluenza virus, adenovirus, coronavirus, respiratory syncytial virus, human metapneumovirus, enteroviruses, and rhinovirus.

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