Marrow Failure - Leucopenia

***Neutrophil count !!!

<1.0 = pyogenic infection
<0.5 = severe risk

FNEs (Febrile Neutropenic Episodes)

Temp = 38.5 x1 or 38x2 w/i 1hr

Ix
Clin exam - severe infection poss from minor inj
Blood M,C&S
Throat sub

MSU

Tx
BSp ABs + change according to sensitivities/if unresponsive to BSpectrum ABs
Continuing fever after ABs = admin of IV anti-fungal agents (amphotericin)

Prophylaxis in Np patients

Barrier Isolation (filtered air & sterile food) = Severely Immunocompromised
Alternatives = Compromise isolation/Home
Compromise isolation = xVisitors with active infections, xFood with bacteria eg cheese, glove & gown

Oral anti-fungals eg nystatin/amphotericin (against oral candida)
x prophylactic ABs except poss LD co-trimoxazole for post-transplant and AIDs pts (against PCP)

Leucocyte Transfusion - from - normal donor treated with G-CSF/pts with chronic granulocytic leukaemia (due to higher no of circulating Nps)


Lymphopenia
Increased risk of viral infections/pneumocystis

Prophylactic aciclovir (against herpes) until T-lymphocyte count > 0.2
Marrow transplant causes immunosuppression * with GVHD
CTx (nucleoside analogues eg fludarabine) also cause immunosuppression