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Granulocytopenia, Emergency Medicine

Reviewed 06/2017
 


Basics

Description

  • A significant decrease in the number of granulocytes in the peripheral blood.

  • 3 classes of granulocytes:

    • Neutrophils or polymorphonuclear (PMN) cells and bands

    • Eosinophils

    • Basophils

  • As PM...

Diagnosis

Signs and Symptoms

  • Signs of bacterial or fungal infection:

    • Fever

    • Localized erythema or fluctuance

  • Signs of pancytopenia:

    • Fatigue

    • Pallor

    • Petechiae

    • Epistaxis and other spontaneous bleeding

History

  • Medic...

Treatment

Initial Stabilization/Therapy

For patients presenting in shock: 
  • Administer 1 L 0.9% NS IV fluid bolus (peds: 20 cc/kg).

  • Initiate pressors as needed to stabilize BP if no response to IV fluids.

  • ...

Follow-Up

Disposition

Risk Stratification

MASCC Score: Identifies febrile neutropenic patients who are at a lower risk of complications. 

Admission Criteria

  • Signs of infection

  • Unreliable patient

  • Close follo...

Pearls and Pitfalls

  • Usual signs of infection may be masked because of the impaired immune response in patients with granulocytopenia.

  • Rectal exams and rectal temperatures are relatively contraindicated...

Additional Reading

  • Freifeld  AG, Bow  EJ, Sepkowitz  KA, et al. Clinical practice guideline for the use of antimicrobial agents in neutropenic patients with cancer: 2010 update by the infectious disea...

Codes

ICD9

  • 288.00 Neutropenia, unspecified

  • 288.03 Drug induced neutropenia

  • 288.09 Other neutropenia

  • 288.01 Congenital neutropenia

  • 288.02 Cyclic neutropenia

  • 288.04 Neutropenia due to infection

  • 288.0 Neutropen...

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