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Importance of Fever and Febrile Neutropenia

What is Neutropenia?

  • Neutropenia is when your neutrophil (type of white blood cell that fights infections) count is very low
  • Neutropenia raises your risk of getting an infection

What causes Neutropenia?

  • Leukemia affects the bone marrow which can affect the white blood cell (neutrophil) count
  • Chemotherapy can lower your white blood cell (neutrophil) count 8-14 days after you get treatment
  • Your white blood cell (neutrophil) count can start to rise 3-4 weeks after chemotherapy treatment

How to tell if you have a fever?

While you get chemotherapy treatments, take your temperature if you feel:

  • Warm, chilled or unwell

You have a fever if your temperature is:

38.3°C (100.9°F) or higher at any time
OR
38.0°C (100.4°F) or higher for 1 hour

What do you do if you get a fever? (while on chemotherapy treatment)

  1. Do not take Tylenol (acetaminophen) or Advil (ibuprofen) before you take your temperature. These medications may hide a fever.
  2. Go to your closest hospital Emergency Department and show your Fever Advisory Card RIGHT AWAY.
  3. Bring all of your medications, including herbal products and vitamins that you take
  4. Tell the person checking you in and the triage nurse that you have cancer, the type of cancer, are receiving chemotherapy treatment and the last day you were treated

What is the fever card?

  • A Fever Card tells you what to do if you get a fever while on chemotherapy treatment and alerts health care providers to your specific medical issue
  • Patient and family members should present the card when they get to the Emergency Department
  • Although your care is a priority, you may still have to wait while other patients with more serious concerns are being treated
  • You should only use the card if you have a fever. If you go to the emergency department with another concern you do not need to show your card.

What are signs and symptoms of an infection?

Often the only sign of infection is a fever**

Seek medical attention right away if you have any of the following symptoms:

  • Fever
  • Chills, shaking, sweats, any “flu-like” symptoms

Let your nurse or doctor know if you have a sore throat, cough, shortness of breath or feel like you may have a fever

**Sometimes you may have a serious infection without a fever. If you have any new signs or symptoms and are worried, please call Sunnybrook Hospital 416-480-4244 (locating) and ask to page the Leukemia Complex Malignant Hematology pager to speak to the Nurse Practitioner or Resident/Fellow On-Call.

Guidelines about infection risk

Most fevers in patients with low neutrophils happen even with good prevention and we often do not find a cause. Usually, they are from bacteria that live inside us. However, we do recommend that you follow these guidelines to help prevent infection.

  • If you have a low white blood cell (neutrophil) count or neutropenia, you have a higher risk of infections
  • You must watch for signs of infection and fever
  • If you get a fever or have any signs and symptoms of an infection it is important to catch it early and get treated right away
  • It is also important to lower your risk of developing infections from others, animals and food