Febrile Neutropenia Diagnostics

A complete blood count (CBC) with differential leukocyte count and platelet count, creatinine, urea nitrogen, electrolytes, hepatic transaminases, total bilirubin should be done. Check the baseline levels to monitor for possible occurrence of drug toxicity and in order to plan supportive care.  At least two blood cultures (BC) from a peripheral vein site and any indwelling venous catheter should be extracted, if present. In pediatric patients, additional blood cultures from a central line during a febrile episode is recommended. Site-specific cultures may be considered such as: Stool, if considering enteric pathogen screen, Clostridioides (Clostridium) difficile assessment in patients with diarrhea; urine, if patient has urinary catheter, urinary tract infection (UTI) or abnormal urinalysis, or routinely among febrile neutropenic pediatric patients; skin, aspirate/biopsy of skin lesions or wounds; vascular access cutaneous site if inflammation is present (routine, fungal, mycobacterial); and consider viral cultures of mucosal or cutaneous vesicular/ulcerated lesions and of the throat or nasopharynx for respiratory symptoms especially during outbreaks. Consider also doing urinalysis and pulse oximetry. In urinalysis, the absence of pus cells does not rule out a urinary tract infection in neutropenic patients. Tests for viral infection such as polymerase chain reaction- and direct fluorescence antibody-based tests, may be considered.