Neutropenic sepsis in palliative care
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Neutropenic sepsis is an emergency and needs urgent medical attention. Help patients to get early diagnosis and treatment by knowing who is at risk and the signs and symptoms.
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What is neutropenic sepsis?
Neutropenic sepsis is a reaction to an infection, which can happen in patients with neutropenia (a low level of neutrophils in the blood). Neutrophils are a type of white blood cell that work as part of the immune system to fight infection. Having neutropenia makes it harder for the body to fight infection.
Neutropenic sepsis is potentially life-threatening and needs urgent medical attention.
Patients most at risk of neutropenic sepsis
Patients with neutropenia (low levels of neutrophils in the blood) are at risk of sepsis. Patients are most at risk if they have:
- severe neutropenia
- long-term neutropenia
- a quick decline in neutrophil count.
Causes of neutropenia
Possible causes of neutropenia include:
- bone marrow disorders, such as aplastic anaemia and myelodysplastic syndromes
- treatments that suppress the immune system, such as chemotherapy or immunosupressant drugs
- stem cell transplantation.
Signs and symptoms of neutropenic sepsis
The signs and symptoms of neutropenic sepsis can be unclear and patients may not have many symptoms. If a patient has neutropenia or is having chemotherapy or other immunosuppressant therapy, look out for:
- reports of feeling generally unwell
- flu-like symptoms
- fever or low temperature
- shivering
- agitation
- changes in behaviour
- passing less urine than usual
- diarrhoea.
Symptoms can also include some or all of the following changes to their skin:
Blue skin
On lighter skin tones this can be seen on the skin, lips or tongue. On darker skin tones, blue may be easier to see on the lips, tongue, gums, under the nails or around the eyes.
Paleness (pallor)
This is often more easily seen in people with lighter skin tones. People with darker skin tones may look greyish. You might see pallor on their palms, lips, gums, tongue, or nail beds.
In all skin tones, you can see pallor by pulling down their lower eyelid. The inside of the eyelid is normally dark pink or red, but will be pale pink or white if they have pallor.
Mottled skin
People with lighter skin tones may have skin that looks blotchy (has different colour patches). Mottling is harder to see on darker skin tones – it might look darker than normal, purple or brownish in colour.
Rash
A skin rash could be pink, red, purple, or darker than the surrounding skin. Skin might be warm to touch, raised, bumpy and itchy.
They may also have a rash that does not fade when you press it. Either use a clear glass to see the colour of the skin or press gently with a finger for three seconds then release.
If you suspect neutropenic sepsis
Neutropenic sepsis is life-threatening and needs urgent treatment.
Contact the patient's medical team for advice. If the patient is having chemotherapy, they will have information from their hospital oncology team on who to contact in an emergency.
If it's out of hours, call 999. The patient will need urgent assessment and antibiotics in hospital.
If the patient does not wish to go into hospital, contact their GP or out of hours service for advice immediately.
Stay calm and tell the patient and those around them what is happening.
Covid-19 and neutropenic sepsis
NICE has more information about covid-19 and neutropenic sepsis, including what to do if you suspect covid-19. Read NICE Clinical Knowledge Summary on neutropenic sepsis.
Useful resources
Key points
- Neutropenic sepsis is an emergency.
- Neutropenic sepsis is overwhelming infection that can affect people who have a low neutrophil (white blood cell) count.
- Chemotherapy and other treatments can cause a low neutrophil count.
- Be aware of signs and symptoms of infection in people who have a low neutrophil count.
- Get help immediately if you suspect neutropenic sepsis. Know who to call in your area.
- Treatment involves urgent assessment and antibiotic treatment in a hospital, unless the patient has refused hospital admission or treatment.
- Keep calm and explain what’s happening to the patient and those important to them.
Let us know what you think
Email your feedback to knowledgezone@mariecurie.org.uk
Disclaimer
This information is not intended to replace any training, national or local guidelines, or advice from other health or social care professionals.
The Palliative Care Knowledge Zone is not intended for use by people living with a terminal illness or their family and friends, who should access our information for the public.
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