Febrile Neutropenia Tổng quan về bệnh

Giới thiệu

Febrile neutropenia is defined as a single oral temperature of ≥38.3°C (101°F) or two consecutive readings of ≥38.0°C (100.4°F) over 2 hours and an absolute neutrophil count (ANC) of <500/μL (<0.5 x 10⁹/L) or an ANC of <1,000/μL that is expected to decline to ≤500/μL (<0.5 x 10⁹/L) over the next 48 hours. Severe neutropenia is defined as ANC <500/μL (<0.5 x 10⁹/L), while profound neutropenia is defined as ANC <100/μL (<0.1 x 10⁹/L).

The risk of febrile neutropenia is directly proportional to the duration and severity of neutropenia.

Dịch tễ học

Febrile neutropenia is common among patients receiving cytotoxic chemotherapy. It is estimated that 10-50% of patients with solid tumors and 80% with hematologic malignancies will develop fever during chemotherapy-induced neutropenia. The mortality rates in patients suffering from solid tumors and hematologic malignancies are 5% and 11%, respectively.

In studies in Singapore, the mortality rate attributed to post chemotherapy febrile neutropenia is between 3 and 8% and is similar to results from American and European studies.

Nguyên nhân

Sinh lý bệnh

The factors contributing to febrile neutropenia include a direct effect of chemotherapy or immunosuppressive therapy on the immune system and on mucosal barriers and immunodeficiencies associated with primary malignancy. Chemotherapy destroys carcinogenic cells but also attacks some normal cells, including essential elements of the immune system. Neutrophils, which are the first line of the body’s defense, commonly decrease during cancer treatment. The fever is related to the production of cytokines, which are mediated by exogenous pyrogens.