A patient with newly diagnosed acute nonlymphocytic leukemia (ANLL) who
presents with neutropenia and a temperature of 40°C should be managed
by:
A. Prompt institution of chemotherapy because the fever is most likely due to leukemia
B. Prompt procurement of culture and initiation of broad-spectrum parenteral antibiotics
C. Administration of granulocyte transfusion to correct the neutropenia
D. Extensive search for an underlying infection and withholding antibiotics until one is found
A. Prompt institution of chemotherapy because the fever is most likely due to leukemia
B. Prompt procurement of culture and initiation of broad-spectrum parenteral antibiotics
C. Administration of granulocyte transfusion to correct the neutropenia
D. Extensive search for an underlying infection and withholding antibiotics until one is found
Ans. B.
Prompt treatment
of the febrile, neutropenic patient with acute non lymphocytic leukemia (ANLL)
is essential and lifesaving. Appropriate cultures should be obtained to
identify the responsible microorganism, but extensive evaluation in lieu of
treatment places the patient in jeopardy of overwhelming sepsis. Because fever
most likely is the result of infection rather than leukemia, institution of
antibiotic therapy takes precedence over anti leukemic therapy, which can begin
once antibiotic treatment has commenced. Granulocyte
transfusions are not indicated at this point but may be considered if the
patient's infection does not respond to antibiotics. Vigorous antipyretic
therapy should certainly not be the initial approach. Should antipyretics be
needed subsequently for comfort, aspirin; which interferes with platelet
function, must be specifically avoided in the patient who is potentially
thrombocytopenic as well as neutropenic.
