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Neutropenic fever is a medical emergency characterized by fever (≥38.3°C or 101°F) in patients with severe neutropenia (absolute neutrophil count <500 cells/μL). This condition occurs most commonly in patients receiving chemotherapy, bone marrow transplantation, or other immunosuppressive treatments. Prompt recognition and empirical antibiotic treatment are critical as these patients have severely compromised immune systems and high risk of life-threatening infections.
Neutropenia results from decreased production, increased destruction, or sequestration of neutrophils, commonly due to chemotherapy-induced bone marrow suppression. With severely reduced neutrophil counts, patients lose their primary defense against bacterial and fungal infections, particularly from endogenous flora. The absence of adequate neutrophils prevents normal inflammatory responses, making typical signs of infection less apparent and allowing rapid progression to sepsis.
Clinical assessment focuses on identifying potential infection sources while recognizing that typical inflammatory signs may be absent due to neutropenia. Empirical broad-spectrum antibiotic therapy should be initiated immediately without waiting for culture results, as delays can be fatal. Risk stratification helps determine whether outpatient oral antibiotics or inpatient IV therapy is appropriate, with high-risk patients requiring immediate hospitalization and aggressive treatment.