Diagnosing and Treating Neutropenia: Q&A With Dr Daniel J. DeAngelo

Before treating certain patients, Daniel J. DeAngelo, MD, JD, of Harvard Medical School and the Dana-Farber Cancer Institute, will council them on the risk of developing neutropenia, which can result in hospitalization or even an intensive care stay.

Neutropenia had first been defined when an analysis of different levels of neutrophils revealed that patients with a neutrophil count of less than 500 had a marked increase in the risk of infection. Here, DeAngelo, who focuses his research on acute myelogenous leukemia, acute lymphoblastic leukemia, and chronic myelogenous leukemia, discusses diagnosing neutropenia in a patient and the associated costs if a patient does develop neutropenia.

AJMC^®: How do you diagnose neutropenia? What symptoms are you looking for and what is the neutrophil threshold?

DJD: It’s interesting that patients with myelodysplastic syndrome are often neutropenic but few of them will get infections. So there’s probably a component of being neutropenic—neutrophils of less than 500—and receiving cytotoxic chemotherapy, which may damage the mucosal barrier, which puts patients at risk for developing really the most severe complications of neutropenia, which is febrile neutropenia, which often warrants admission to the hospital, and broad-spectrum antibiotics.

AJMC^®: What is the cost of care associated with treating neutropenia?

DJD: Patients with neutropenia are at a risk of infection, sepsis, bacteremia, and the cost is hospitalization, broad-spectrum antibiotics, often anti-fungal therapy. And many patients become profoundly sick with sepsis or sepsis-like syndrome, requiring an intensive care stay.

AJMC^®: Are patients often educated in advance of treatment about neutropenia and how serious can it be?

DJD: When I see a patient when I’m administering chemotherapy or a patient who has chronic bone marrow failure, resulting in neutropenia, I always council them and I give them very explicit instructions to call the office or page the on-call physician if they develop a low-grade fever, which I define in Fahrenheit scale of 100.5. And to really seek emergent medical evaluation for a fever of greater than 101.

So I council patients; I always document in my note that patients know they’re at risk of an infection and that any fever may be the result of a life threatening infection.