Agranulocytosis. Febrile neutropenia
1. Big picture
Agranulocytosis and febrile neutropenia are infection emergencies caused by severe neutrophil deficiency.
The exam pattern is:
fever + sore throat/oral ulcers + very low neutrophils ± recent drug or chemotherapy exposure → think agranulocytosis/febrile neutropenia.
The clinical rule is:
Fever in a neutropenic patient is sepsis until proven otherwise. Do cultures, but do not delay broad-spectrum antibiotics.
The Debrecen hematology textbook defines neutropenia as reduced neutrophil granulocyte count, febrile neutropenia as neutropenia accompanied by fever, and agranulocytosis as severe neutropenia with absolute neutrophil count below 0.5 G/L, very severe below 0.1 G/L.
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