Patient Encounter 2 Part 1 FN

FG is a 73-year-old male with extensive stage small cell lung cancer. He has a 100-pack-year history of smoking, hypertension, and has oxygen-dependent chronic obstructive pulmonary disease (COPD). He has poor appetite and has lost 9.1 kg (20 lb) in the last month. He is a 3-year survivor of stage IIIa colorectal cancer (CRC), which was treated with surgery and six cycles of adjuvant combination chemotherapy (5-fluorouracil, leucovorin, and oxaliplatin).

What risk factors for FN does this patient have?

What signs and symptoms of infection would you counsel this patient to watch for following treatment?

Fungal infections due to Candida species (especially C albicans) have emerged as significant pathogens, especially in patients with hematologic malignancies and those undergoing bone marrow transplantation (BMT). In addition, Aspergillus species are important pathogens in patients with prolonged and severe neutropenia.

The neutrophils are the primary defense mechanism against bacterial and fungal infection. Most infections in neutropenic patients are a result of organisms contained in endogenous flora, both on the skin and within the GI tract. These organisms are provided access to the blood stream through breakdowns in host defense barriers (mu-cositis, use of central venous catheters). Mucositis in particular is a significant risk more common due to the widespread use of ag-

Neutropenia is defined as an absolute neutrophil count (ANC) less than 500 x 10%L (500 x 109/L) cells or an ANC less than 1,000 x 103/|L (1,000 x 10 9/L) cells with a predicted decrease to less than 500 x 103/|L (500 x 10 9/L) cells. The ANC is calculated by multiplying the total WBC by the percentage of neutrophils (segmented neutrophils plus "bands"). Fever is defined as a single oral temperature greater than or equal to 38.3°C to 38.0°C these two factors defines FN.19 The risk of infection during the period of neutropenia depends primarily on two factors:

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